CSM Community,

How do you handle customer service when each case has three customers? I work in a workers' compensation clinic, where we care for injured workers. So each case has three customers: the patient (injured worker), the employer and the insurance carrier. Sometimes these customers have conflicting agendas. To make matters more interesting, there are a moderate amount of regulations and the environment is fairly litigenous.

Any suggestions on how achieve excellent customer service under these circumstances? Can you suggest articles? Books? Thank you.

Dave

Your main customer is the patient for whom you work within the parameters defined by your employer and the insurance carrier.

Just need some clarification on what you mean by "litigenous environment"

You obviously have 3 customers - the patient as your primary and the employer and the insurance company are your secondary customers. I can understand that there would be regulations but each needs the same basic customer service but tweaked a bit for their own "needs" in the situation.

Listening, aligning, empathizing, respecting , problem solving and resolution -all within the guidelines of your job responsibilities set by your company...and the regulations in place from the insurance carrier.

Sometimes its not easy but it is rewarding if you like this type of job.

By "litigenous" I mean likely to have some sort of legal action, or involvement of attorneys.

To put this into a practical situation, for example:

An injured employee believes s/he has a serious problem and wants an expensive test (such as an MRI) done. The employer and/or insurance carrier disagrees and does not consider this expensive test justified.

Whether or not the test is medically necessary is not the focus for now. What I would like to know is, how to handle this situations from a strictly customer service perspective? To order the test alienates the payer(s). Not to order the test alienates the employee/patient. Is there a body of literature and/or experience for these types of situations?

Thank you.

Epensive tests such as mentioned would normally be done on a Doctor's prescription. Even if the patient is adamant on his own to have the test, you can inform him that the insurance may not be paying for it and the test can be ordered if he (the patient) is ready to pay.

In case of further dispute you may try and initiate a direct dialogue between the patient and the insurance carrier.