I was speaking with someone the other day who suggested I write about dealing with health insurance companies. He had just had a frustrating morning on the phone.
I’ve been there, on both the doctor’s side and the patient’s side of the phone call, albeit never on the insurer’s side. Fewer activities are more maddening, but in my personal experience they have tended to work out ok.
In general, I would rather get sunscreen in my eyes than have to call my health insurance carrier. However, since I’m really not given a choice between the phone call and the sunscreen, I have to make the call. There are some ways to make the experience a little better.
First, it always helps to be prepared. Have your insurance card with you so you have quick access to all the numbers you might need (contract number, group code, plan code, ID number, etc.). Also make sure you know the last four digits of the social security number of the primary enrollee (i.e. the person through whom you obtain your insurance – your self, your spouse, your parent…) since the person who eventually answers your call may not talk to you if you can’t confirm who you are with this number. They may also ask you to confirm your address, but most of us don’t find this too difficult to remember (unless, of course, we have steam coming out of our ears because we’ve been on hold for an hour…).
Why are you calling your health insurance company? Write down your questions and leave space between them to write down answers later. If your issue is that something was not covered that you had thought would be, have your EOB (Explanation of Benefits) statement from the insurance company in front of you that has the code or explanation on it regarding the issue of concern. Also have your billing statement from your doctor’s office or the hospital/clinic/etc. for this particular issue in front of you as well. Make sure the dates of service match, and you know what your bill was for in the first place. Many times, a quick call to your doctor’s office (or doctor’s biller) will clear things up, and they may be able to explain your insurance company’s response and figure out what the problem is. Write down the name of the person to whom you’ve spoken and what she has said regarding the situation. Date these notes.
If you still have not had your question answered or problem resolved after speaking with your doctor’s/hospital’s billing office, ask them the name of the specific person to whom you should refer your insurance company’s representative. Then it’s time to call your insurance company.
Never make that phone call to the insurance associates when you only have a few minutes before you need to leave for a meeting. You will never be done within a few minutes. Know that you will be sitting on hold for a long time and plan accordingly. Put your telephone on speaker phone and as you dial, put your relevant papers close by and hop on your treadmill or exercise bike. Work on other paperwork. Gather a few puzzles and work on them. Open another window on your computer and read through old DocThoughts blogs. Watch Youtube videos of puppies. Listen to some TED talks. After you’ve punched in your contract/ID number and made a few menu choices, you will be making good use of the time that you are stuck on hold.
It’s amazing the difference this makes in your blood pressure and overall ability to speak coherently once someone answers.
Speaking of someone answering, write down the name of the person who picks up your call. Ask each of your written questions and write down the answers that the insurance representative gives you. Ask for clarification of anything that is not crystal clear. If you are not receiving a satisfactory response to your questions or concerns, ask to be put through to a supervisor and then write down the name of the supervisor with whom you speak. Ask for and write down the name of any person with whom your doctor’s office needs to speak.
Medical billing is remarkably complicated. Do not feel stupid if you don’t understand it. Breathe deeply, and stay calm while you talk. Don’t view the person on the other end of the phone as your enemy – yes, your insurance company makes money, but it does so through providing help to its customers. Consider the person on the phone to be your ally – it will show through in your voice, the conversation will go more smoothly and pleasantly, and the person to whom you are speaking will be more genuinely interested in assisting you.
After you have received all of the relevant information from your insurance carrier, report it back to the appropriate person in your doctor’s office/hospital/etc.. In the rare cases that concerns or disputes are not able to be resolved, it may be helpful to engage the services of someone who specializes in such matters.
But most of the time, facilitating good communication among the involved parties will resolve your issues.
I had no idea medical billing was so complicated until I had to pay some hefty medical bills. But you’re right: having patience is definitely an asset when dealing with insurance issues.