Refund Promise

The Refund Promise program desires to show ethical commitment to its patients and families that poor service is unacceptable and financial risk will be incurred by the system for such failures. The program’s guiding purpose is to put the patient at the center of the interaction, and demonstrate healthcare’s responsibility for the totality of the experience patients and families encountered. How does this build trustworthiness? The Refund Promise makes the health system accountable for its hospitality and the reliability of the services it provides to the community.

How It Works

Starting in 2015, Geisinger Health offered a refund for poor patient experience outcomes as part of a general service recovery commitment. The refund was limited to co-pays, deductibles and co-insurance in both the inpatient and outpatient settings.

Taking a lead from consumer markets, a “no questions asked” refund policy was integrated into the system’s overall mission to make everything it does be part of “caring”. It was argued that if failures occurred in communication, empathy, efficiency, or hospitality, a patient should have their financial contribution forgiven or adjusted. Issues revolving around quality, safety and medical management were excluded. Frontline patient advocates were empowered to manage refunds at the earliest entry of the complaint. Office managers, front desk assistants and inpatient leaders were given the authority to make real time decisions to provide a refund when asked or when the situation demanded it.

Ultimately, the system desired to show an ethical commitment to its patients and families that poor service was unacceptable and financial risk would be incurred by the system for such failures. To use a common phrase, the health system would now have “skin in the game”. Difficult cases would be mitigated by leadership in the patient experience department to make sure the promise was applied with integrity and in consistency with its goals.

The refund promise remains active at Geisinger and has prompted ongoing discussion on service recovery and has set an example to other systems worthy of imitation. Its guiding purpose is to put the patient at the center of the interaction and demonstrate healthcare’s responsibility for the totality of the experience a patient and family encountered.

Skills and Competencies

The refund promise relies heavily upon the patient advocates/liaisons since they are the focal point for many of the conversations around service recovery. However, front line staff and operational leaders must be empowered to utilize the refund in real time, even as a poor service experience is actively occurring.

Also critical to success is system executive leadership buy-in and support for their teams in using the refund to offset poor patient experiences.

Moreover, the system should establish guidelines to avoid application in areas it should not be used– medical diagnosis and therapeutic decisions, surgical outcomes, or the overall cost of care.


The promise was made by Geisinger’s new CEO, Dr. David Feinberg, in the fall of 2015. Recognizing that consumerism and competition were part of the future of healthcare, he felt that the refund promise tangibly represented Geisinger’s commitment to the patient experience and getting it right–each and every time. Based on Geisinger’s prior ProvenCare model, which tied set clinical reimbursement to quality standards, the refund promise toggled patient experience to financial risk. The goal was to build trust between the system and the community it served–much like service guarantees in other industries.


In personal dealings with patients and families who were offered refunds, they clearly shared that it enhanced the trust they had with the system. At a very basic level, it was the leveling of the playing field as more important discussions on service recovery and improvement moved forward. Initial data suggested an increase in the number of complaints and grievances handled by the system. However, this was seen in a positive light as a method of identifying pain points for patients and clinical processes worthy of performance improvement projects. The financial risk remained relatively low in comparison to the overall revenue stream of the organization.


The practice is employed throughout all 12 hospitals in the system and all clinical sites. It also applies to Geisinger’s own health plan. The refund promise was broad in its execution and can be adopted easily by other systems– as long as they appreciate that the inherent risk does not outweigh the benefits gained in integrity, consumer appreciation and overall trust.