Michael Maoz

A member of the Gartner Blog Network

Michael Maoz
VP Distinguished Analyst
13 years at Gartner
26 years IT industry

Michael Maoz is a research vice president and distinguished analyst in Gartner Research. His research focuses on CRM and customer-centric Web strategies. Mr. Maoz is the research leader for both the customer service and support strategies area and customer-centric Web… Read Full Bio

Coverage Areas:

Does President Obama manage his own health benefits forms?

by Michael Maoz  |  June 25, 2009  |  3 Comments

As I listened to the US President Barack Obama answer questions about healthcare reform Wednesday night on television, my mind kept going over the scenarios from my own family: on forms submissions, claims to insurance companies, incorrectly-cancelled services, failed notifications, denials of coverage, faulty claims codings, failures to inform or support – that my family of five has been on the receiving end of over the past 11 years.

How many countries with the standard of living in the US could claim to have the complexity of forms and procedures for health issues? I just tried to execute a simple change of address. I couldn’t even proceed on my insurer’s website until I logged in, even though the question I had was simple: how do I change my address in the system? I used the search engine and the knowledge base, but received three utterly irrelevant choices. In frustration I called the customer service folks. After flailing around in an IVR for six minutes, I punched out to a ‘live agent’ who told me that only my employer could change an address. No worries. I asked if there were some way she could make a note to the people who do Q/A or FAQ on the website. Her answer, “No sir, because we don’t handle address changes: your employer does.” OkeyDokey.

One of my daughters had her wisdom teeth extracted in two sessions. In the first, the procedure was covered. In the second it was denied. Huh? After four phone calls it turned out that one wisdom tooth (or maxillary and mandibular third molars for you purists) which was impacted was assessed by the outsourced medical technician to no longer fall under the category of “dental’ insurance” but ‘medical’ insurance. They denied the claim. No, they did not know of the other extractions at the time of assessment that were accepted as ‘dental.’ Did it all work out? Sure: after denial of claim, clarification of problem, resubmission of new claim to medical, and, of course, calls to my company’s HR and my physician.

Has anyone ever tried to add up the billions and billions of dollars that are wasted in lost time, duplicate forms, and extra personnel?

So there I was, listening to the President and imagining him completing another medical form, waiting on hold, and discussing North Korea’s missile threat. There’s got to be a better system.

3 Comments »

Category: CRM Customer Centric Web Innovation and Customer Experience Social CRM Social Networking Social Software     Tags:

3 responses so far ↓

  • 1 Kate McNeel   June 26, 2009 at 1:05 pm

    Michael,

    Love the image of President Obama filing insurance clams. Let’s require all members of congress to fill out all of their medical forms for the next 12 months, and then see what sort of healthcare reform we can come up with!

  • 2 Esteban Kolsky   June 27, 2009 at 11:33 am

    Michael,

    what you are talking about is deeper than health care reform. it is about the experience.

    one of the sine-qua-non we talk about when designing experiences goes beyond asking the customer into the realm of common sense: would you use this process as it is? is there anything you would change? if you were the customer, what would you think?

    i worked with Kaiser for a while many years ago, and the thing that impressed me the most was that at the time, and this was way before experience became a buzzword, they would apply that test to all systems they produced.

    I am certain that Kaiser has its own battles to fight on experience – as do all organizations – but it is a simple method to see if the process or experience would make sense.

    can you imagine any insurance company applying this test to their procedures? of course, they would have to close…

  • 3 uberVU - social comments   November 9, 2009 at 6:49 am

    Social comments and analytics for this post…

    This post was mentioned on Twitter by TweetCRM: Does President Obama manage his own health benefits forms? http://tinyurl.com/la3qkm