What’s A Girl Got To Do To Get An HMO To Help Her?

What lengths do you have to go to to get good coverage from an HMO? Being sick obviously won’t do it. So what about starving yourself? Well, not if your HMO is Blue Cross Blue Shield.

Patrick M. wrote in to talk about his recent experience trying to get his wife a blood test. “This is a story of poor health care and not the typical they-are-refusing-my-coverage stuff. Just poor customer service.”

And it is that. Nothing like fasting for 12 hours only to find out that your HMO never bothered to make you that appointment. His wife’s ordeal, after the jump.

So I know this might be some uncharted territory for you guys, however, I thought I’d give it a shot.

This is a story of poor health care and not the typical they-are-refusing-my-coverage stuff. Just poor customer service.

My wife and I have blue cross blue shield – so in the realm of health care, it’s supposed to be “good” (if course, this is all relative). My wife had to make a blood appointment for some blood test, she had to go through the ever large company Quest Diagnostics. Since Quest is a this national corporation that supposedly has efficiencies of scale they made her call a 1-800 number to schedule the time and location of said test. When she called the operator said there were no locations in our area. Thankfully our doctor had supplied two locations. Needless to say, somehow the operator then found said locations and made an appointment. My wife then asked if there was anything else she needed to know. The operator acted as if this was a crazy questioned. My wife asked if she needed to fast before the appointment. “oh, yea, yea, you need to, ‘um, fast for 12 hours before your appointment.” After fasting fro twelve hours my wife showed up to her appointment – or what she thought was her appointment. The local quest office did not have her down for an appointment and made her wait for over an hour till they could accommodate her.

So to sum:

National corporation does not post numbers for local offices and instead makes you call a 1-800 number where, in theory, they have highly trained operators

Said operator can not find location

Said operator schedules appointment and does not inform patient of the need to fast beforehand

Locale Office has no appointment and make patient wait over an hour

So, we are consumers and are wondering what is the appropriate level of customer service for this type of incident. Why should retailers and direct to consumer brands work to give a customer a satisfactory experience (e.g., a coupon) and not someone like Quest?

I’d like to hear your thoughts on the matter should you feel it appropriate.

The problem is, of course, that you can’t easily switch insurance providers, a lot of times. Therefore, there’s no incentive for them to try to keep your business.

Comments

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  1. alogarfa says:

    I’ve had similar problems with Quest. When my doctor wants me to get blood tests, he gives me a prescription pad with all the tests stamped on it. The stamp is a shortcut because my doctor’s handwriting is fairly illegible. He circles the tests he wants done.

    In my four visits using this system, the diagnosticians have failed to do the correct tests 3 times. Once, they did all the tests; once they did only the uncircled tests; once, they did a random sampling of tests; and the time they got it right, they had to ask me what tests I needed. They’ve gotten it wrong with my girlfriend too, giving here a prostate blood test instead of the cholesterol one.

    From what my doctor says, it’s not limited to the testing center that I go to, they have problems with Quest all the time.

  2. acambras says:

    Quest seems to be the only game in town here in Connecticut — every time I’ve had any doctor refer me for a blood test, they send me to Quest.

    The people who’ve drawn my blood have always been efficient, professional, and friendly — it’s just getting to them that’s tough. Their front desk staff is sometimes pissy, and the call center employees (1-800) that book the appointments know NOTHING, especially if it’s a fasting test. My advice — get the instructions from your doctor about fasting. But DO try to make an appointment. A month ago I was able to breeze in past 15-20 walkins languishing in the waiting room — I was in and out of there in 5 minutes. I felt like a VIP — a celebrity. Like Paris Hilton, except nicer and prettier. And without a yappy little dog in my purse.

  3. therockandthehardplace says:

    I’m a little confused; I’ve used Quest in the central New Jersey area for the past two years. My GP or my endocrinologist just fill out a form, checking off what they need tested, then tell me I have to bring said form to my blood test, and be tested by a particular date.

    I show up as early as possible (they open at 6AM over here), and I’m usually out the door within 30 minutes. I have NEVER during my two years’ experience had to call their 1-800 number for an appointment.

    My doctors told me what to do about fasting, and when I called for my first Quest appointment querying their nearest location, whoever picked up the phone was also kind enough to advise me to fast for twelve hours.

  4. kerry says:

    If you live in an area with a large hospital, the chances are good that the hospital has its own lab. If you can find yourself a doctor at this hospital, you will probably get better customer service when dealing with blood testing, since your blood test will be ordered on the hospital system, drawn at the hospital, and tested at the hospital. You deal with everything locally like that, avoiding national corporations like Quest, and your blood is less likely to be lost or otherwise mistreated. Find out which area hospitals have their own labs, then find out which doctors associated with those hospitals take your insurance (if it’s something big like BC/BS, you shouldn’t have much trouble).

  5. Every doctor I’ve been to has had a nurse draw the blood and it gets sent to a lab if necessary. I take it this is not the norm?

    As far as getting help from an HMO, I suggest blackmail.

  6. RandomHookup says:

    Benny Hinn is a real winner. The Baptist Book Store chain wasn’t allowed to stock his books, only special order them. Pretty bad when the Southern Baptists ban you for being too much.

  7. Ishmael says:

    Tell me again how this is her HMO’s fault?

    The times I’ve used Quest, I haven’t had a problem. The doctor’s office gave me a form, sent me over there, and I had no more than a 15 minute wait. However, that has been awhile. My doctor is part of a group with their own lab. I see the doctor, walk down the hall, get stuck, and leave. I get a letter a week later with my results.

  8. Smashville says:

    Why would you expect the operator to be able to answer questions related to the procedure? Shouldn’t that be a question for your doctor?

  9. Smashville says:

    “What lengths do you have to go to to get good coverage from an HMO? Being sick obviously won’t do it. So what about starving yourself? Well, not if your HMO is Blue Cross Blue Shield.”

    “And it is that. Nothing like fasting for 12 hours only to find out that your HMO never bothered to make you that appointment. “

    “The problem is, of course, that you can’t easily switch insurance providers, a lot of times. Therefore, there’s no incentive for them to try to keep your business.”

    Did you even bother to read the complaint? What the hell does the HMO have to do with any of it?

  10. kerry says:

    Smashville -
    Generally speaking, the person who makes appointments for a lab, whether it’s a local lab or a national one like Quest, should know whether or not any special needs are required for that test, like fasting beforehand. Every time I’ve had blood work done it’s been the lab that says “don’t eat 12 hours beforehand” when I make the appointment, because my doctor has submitted the order as “fasting cholesterol” and the person who makes my appointment conveys that to me when she sees my order. Same thing when I had some oral surgery. Everyone I spoke to at the dental office reminded me not to eat or drink for 12 hours before the appointment. It’s not some secret knowledge only doctors are in possession of.

  11. Smashville says:

    This is true, but my bigger issue with this complaint is that Consumerist makes it look like she should switch her insurance company when the HMO has nothing to do with it other than paying for it.