Harder than pulling teeth: dealing with a foolish consistency

Photo by cottonbro studio: https://www.pexels.com/photo/an-x-ray-image-of-a-jawbone-in-the-computer-6502014/

                                                          

A dentist practice is the setting of this story, so the title reference is particularly apt. The foolish consistency reference alludes to Emerson's observation, "A foolish consistency is the hobgoblin of little minds." 

When that kind of foolish consistency translates into a blanket policy, the hobgoblin hobbles progress and finding better solutions to problems. It took my considerable persistence to point out the WHY of the policy in place and offer a solution that was better all around than blind adherence to the blanket policy.

One troublesome tooth was the cause of multiple dental visits this year and procedure that you likely don't want to hear about. I have dental insurance, but there is always a copay due for any work done, and the dental office likes to collect on the spot based on what its own estimation.

I don't mind that and do offer my HSA card to cover the charge. The problem arise when the office's estimations proves to be a bit off. 

If insurance paid less than it had anticipated or somehow adjusts the numbers in some way, the office then mails a bill for that difference -- and it's been as little as $3. For this particular visit, it amounted to $9.30, and there's the rub.

The office has adopted the policy not accepting any form of card payment -- including the HSA one -- for any amount under $25.So what happens when the patient share of the cost tops $25 but the dentist staff insists on your paying an estimate that opens up the possibility of a balance due under $25? 

Then the patient is deprived of using the HSA of FSA funds earmarked specifically for this purpose because the office won't accept the card payment. I had previously handed over the cash for a $3 balance and was even prepared to pay cash for this balance, but the office itself messed that up.

After I got the bill for $9.30 in the mail, I told my husband to take care of it when he had his checkup. He offered a $10 bill, but that didn't fix things because the office had no change. The woman who should have taken the money then told him to just hold off.

So that is where we were a few weeks later when a second bill came in the mail. Has it started to dawn  on you that the dentist office had already shelled out $1.20 in postage to mail out the bill twice? 

Blanket policies intended to save money actually end up costing more

That amount is substantially higher than the loss the practice tries to avert from its blanket policy, as the dentist confirmed.  The card processing costs  5%.  For a payment of $9.30, the loss to a fee is less than 50 cents. 

 In other words, the fees on these small balances typically amount to less than the cost of a stamp. But the office will automatically mail out a bill every month to try to recoup the $9.30 while absolutely insisting that it cannot take a card payment, though that would have eliminated the need and cost of the mailed invoice. 

The foolish consistency that defines the dentist's  blanket policy leads to an irrational approach that exemplifies false economy:

Irrational as that is, I did not begrudge my dentist's avoidance of loss due to fees. I told that woman in the office that I will cover the fee. She can just add it on to the amount due on my card. That way, I get to use my HSA funds as they were intended, and they don't lose out. 

She would not be budged, repeating the policy line for the fifth time. Finally, the dentist finished what he was doing and came out. He reiterated the policy, but he was willing to accept my offer to cover the fee. 

What I find particularly funny in all this is that while the dentist stood by adhering to a policy, he questioned why my husband had not just left the $10 without getting 70 cents  change.  Well, the reason is because the office person got flustered when she didn't have change and told him to just leave it.

But it's pretty astounding that someone who will inconvenience his customers and now allow them to use their HSA cards for payments to save that 5% on small amounts things that payers should not give a second thought to overpaying by 7% -- even if they can have  it "on account." Don't forget to apply my 70 cent credit!" 

A couple of weeks later

A couple of weeks after I posted this, I was reading Don Norman's The Design of Everyday Things  and learned that there is a term for exactly what blanket policies thwart: a root cause analysis intended to solve the actual problem. 

  Sakichi Toyoda, whose name morphed into that on the motor company brand, called it the 5 Whys. He posited that when something goes wrong, the first why is rarely the root cause, and you have to dig back through 5 layers to get to the first cause of the problem. 

The idea that there is a whole chain of causation to outcomes is famously encapsulated in an account of how a nail caused the kingdom to be lost: 

For want of a nail the shoe was lost.
For want of a shoe the horse was lost.
For want of a horse the rider was lost.
For want of a rider the battle was lost.
For want of a battle the kingdom was lost.
And all for the want of a horseshoe nail.

If you stop after just one or two whys here, you wouldn't trace the loss of the rider al the way back to the loss of the shoe due to the want of a nail. 

In the instance of the dentist policy, it didn't even take that many layers of questioning -- just one Why, as I did. But I first had to stand my ground with great tenacity in the face of the repetition about the policy.