We're here to educate consumers on healthcare. We will discuss everything from Healthcare Reform to quick tips in making complaints. The patient is an integral part of the healthcare team, and we will help you get an insider's view on how to navigate the healthcare system.

Monday, July 5, 2010

Quick Tips

You want action from a Healthcare company or insurer, but you aren't getting anywhere over the phone or in person with the folks you interact with, here are some quick tips to escalate as needed.

1. Don't threaten to sue unless you really do have a case, i.e. true neglect or malpractice. These companies have large legal armies ready to go to battle, but we all know that you're blowing off steam. When I hear that you're 'going to sue' I think you have lost your mind. Instead, ask if you can work with the company to make the situation better. Some companies have quality committees that allow patients and their families to participate. Be the solution, not the litigator.

2. Be polite when you complain, and never curse! Using profane language discredits your argument and gives me and my staff the right to hang up the phone or ask you to leave. We know that we're not perfect in healthcare, but bad language doesn't help anyone fix anything.

3. Do talk to your healthcare team. Chances are most of the issues that come up can be worked out amongst the team, and you (the patient) are part of the team.

4. Ask for a second opinion. Remember that medical professionals are in the business to help people. They are not in the business to give out prescriptions or slips for work. They will do what they feel is medically appropriate. Two providers can have opposing views and that is okay, and it does not mean the one you do not choose to listen to is an idiot.

5. When communication fails, complain to management. In general, the squeaky wheel gets the oil, and healthcare is no different. In fact we have many agencies (like CMS) that dictate the time we have to respond to complaints. Caution here - don't think that everything warrants a complaint, and not every complaint will resolve the issue the way you want. However, complaints tend to form patterns that we observe and address the root cause of the pattern (i.e. phone call response time). This doesn't happen over night, but we do need to know.

6. Be realistic. Don't expect a phone call from your provider or healthcare team in anything less than 2-3 hours. If you can't wait that long, chances are you need to go to the ED or urgent care. We try to respond as quickly as possible, but urgent matters take precedent.

7. Be patient, but be zealous. We are a customer service business like no other. Life and death decisions are made daily in clinics and hospitals, insurers impact your financial health as well. Please understand that with that weight on our shoulders, we often err to the side of caution and conservative approaches. If these are not meeting your needs, talk about it with your healthcare team and give constructive feedback.


  1. Hi there,

    I read your blog and wanted to know what quality committees are? I also wanted to let you know that I found your tips very helpful. Thank you for the in site.

  2. Quality committees are a tool for care delivery facilities to respond to care gaps and quality concerns brought up y staff and patients. Any misses or near misses by the healthcare team are discussed as well, some groups discuss recent big news stories to strategize on how their organization would respond. Some of these groups will allow 1-2 members to be patients (thoroughly screened) in order to add the 'customer' dynamic to the conversation. It can be a legal nightmare (thus the screening), but most companies that I've heard of including patients are quite pleased with the outcomes.


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