Remember that time you called your doctor’s office and you got the hospital’s automated voice system. You landed in a type of purgatory where even if you pushed “0” for the operator, you might or might not get a human being. Well I landed there in a recent issue with a local health insurance company. 

I got the automated system and I typed in my account number and went to what I thought was the right service where the automated voice asks for my birthday to better assist me. I got an operator. Woohoo. What’s the first thing she asked for? He asked, “Can I get your account number and birthday?” Wait a minute, didn’t I just do that? I explained my challenge. It was pretty significant. I had them look at the numbers with me. I had exceeded my “out of pocket maximum costs by $3,000.” In other words they owed me money. He looked at the numbers. I asked him to add them up. “Oh, let me get someone who can help you.” Well. You know what happened next. I went from operator to operator where they tried to figure out what happened. That said, I ran out of time and patience and made no less than seven different calls until I finally figured out what was wrong. Getting to that person was no easy task. 


Once I knew specifically what happened and how the overcharge occurred, the operator I was working with suggested I file an appeal. I did. I heard they received it, but never that it was resolved. I refiled the appeal and heard nothing. I went to the Secretary of State website, found the legal counsel, and wrote them and sent the same package of information. Finally, someone called me. It took an additional six weeks, after a previous period of six months, to get a reimbursement check from the insurance company. 

I share this story because Partners for Impact has been working with a client that wants to get a wide variety of input from the community. There is a commitment from this particular local funder to support reimagining the human services system experienced by clients. The goal is to improve referrals and work with whole households to improve their economic well-being. At some point, providers were in the room and they talked about the challenges of referrals between them. They admitted the system was “broken” and that something else needed to be done. There was a short discussion asking the people we serve to help us design this, and I thought, “Whoa! Nope.That is not the route to go.” 

The lessons from my own experience were applicable and I started sharing them. 

  1. Customers/clients behave based on their experience of the broken system. 

I got frustrated with every call I made. None of the front line operator’s could help me. Some said they would call back, and didn’t. My call was often dropped when transferred. One operator hung up on me (I did yell at her). I began only telling them what they needed. I got very specific about the information I had been told so that I could find the right person to help me. I was routed to the finance office, the pharmacist (a different company), and some other places that I can’t remember. I was laser focused on what would work to get me what I really needed. I also had the patience and persistence to go farther up the accountability chain, when that chain didn’t work. At one point, I felt like quitting, but then I remembered the amount that I was owed.  

  1. It is not the client’s responsibility to solve the current system’s problem. 

There is no way that I would even be capable of helping a health insurance company analyze the customer service system’s problem and generate ideas for solutions. I simply do not have that expertise. It is also not fair for us to expect that someone who is seeking some sort of service ie., shelter or food should be responsible for helping us design a better communication and referral system between agencies. 

  1. It is our responsibility to engage customers/clients about their experiences of the system, beyond simple satisfaction. 

I filled out those end of the call questionnaires, when I wasn’t dropped. But those questionnaires are automated and the answers were not reflective of my experience. Despite negative responses, it didn’t seem to make a difference in my next conversation with a different customer service representative. 

Asking service recipients if they were satisfied is one thing, but do we listen and does it matter? What if they weren’t satisfied? What do we do? Am I really likely to have stuck around to tell you I was dissatisfied? There are ways we can engage service participants, and it has to be done with their consent and we have to compensate them for their lived-experience of the system we are trying to reimagine and create.