By Vik Khanna
I have a challenge for CIGNA CEO David Cordani. Sometime this week, pick up the phone and be a secret shopper. Call your customer service team and ask them the same thing I asked them on a Friday not long ago: does my plan cover and reimburse for flu shots, and at which participating providers in my area? This is managed care and wellness 101. Just not at CIGNA.
Customer service rep A says shots are covered and reimbursed, but she cannot confirm any place in St. Louis as a par provider that would bill the plan directly for payment. Her stubborn refusal to grasp the meaning of "par provider" was infuriating. She repeatedly reads a list of potential providers (all national companies, such as Walgreens) and then tells me I must call each location to discern its billing practices.
Wrong. Just plainly and simply wrong because they're all signed to national contracts. Then, while both my German Shepherds headed for cover in another room, she hung up on me. (I was angry but never profane or malevolent.)
Undaunted and now even more frustrated, I call customer service again. Customer service rep B says: shots covered fully and each location noted previously is a par provider that will accept assignment. Done, right? Not yet. Customer service rep A calls me back.
She has not, however, learned anything in the intervening 15 minutes, as she returns to her home base of ignorance with the accuracy of a GPS. Finally, I demand a supervisor. With the supervisor comes enlightenment and lower blood pressure.
The supervisor acknowledges that I am 100% correct. All the entities named by rep A are par providers. The problem is that they are also all pharmacies, and counter service people in some locations erroneously billed the flu shot to the pharmacy benefit rather than the medical benefit. Hence, CIGNA enrollees were wrongly coerced into paying up front and submitting a claim. Inexplicably, this information has not been shared uniformly with the customer service team or their care partners, but my volcanic tutorial has now made her realize she needs to do so. Wow. Ya think?
So, Dave, answer this for me. If your people can't get something this simple straight, as we are well into flu season and the unleashing of hell, er, I mean health reform, how can anyone take seriously that you and your ilk are actually going improve the nation's health? Success requires doing small things well, even flawlessly, because that's how you set the stage for success at bigger things. Like being a triathlete, right, Dave? Tell us about how you've done in the 125 triathlons you've completed when you took the little things for granted.
Vik Khanna is a St. Louis-based independent health consultant with extensive experience in managed care and wellness. An iconoclast to the core, he is the author of the Khanna On Health Blog. He is also the Wellness Editor-At-Large for THCB.
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