Phone Fun

I am being facetious because there is nothing fun about phone calls with insurance companies, Medicare, Veterans Administration or even healthcare providers. I already told you a little about my first call to Veterans Administration in “The Inquisition”. Once you actually get past being qualified to speak to the representative in regard to your loved one’s information, then what? Here are a few suggestions.

First and foremost, don’t be in a rush when you make the phone call. Allow time for being on-hold, being qualified, and figuring out the right person you need to speak to. Most of the time you will need to go through some kind of automated system and press various buttons to even get to speak to a human being. Be patient. If you think the call should take 15 minutes, give yourself 45 to allow for all the unknown variables that are sure to happen. You are sure to be transferred a few times.

Plan ahead and make sure you have all the documentation you need at your fingertips. I already mentioned that when you call Veterans you need to know your loved one’s branch of military, discharge date and other military specifics. Have the discharge papers readily available. When you call the insurance company or Medicare HMO, have your loved one’s card with policy ID ready. Years ago they used to ask for social –and they may ask for the last four of your loved one’s social, so commit that four digit number to memory, and memorize their date of birth.

Other information to have available is the Explanation of Benefits if you have questions on coverage information and if you’re being billed from your doctor and you don’t understand why your benefits didn’t cover the charge amount.

When you finally get someone on the phone, take your time. It goes without saying, but be respectful and do not get frustrated as they will not help the situation. Take notes and be sure to write down in a notebook the date you called and the name of the person you spoke to. Some places actually give you an ID number for the representative and they may give you a reference number for the call –write it all down. They should be documenting in their system notes on the call as well.

Typical questions will be the date of service, which is the date you saw the doctor, nurse or generally received care, the name of the provider, and some information about the service –was it an office visit? Lab? MRI? They may ask diagnosis, but that isn’t too common. They will probably ask the charge amount.

Once they look up your information, be sure to ask them why they paid what they did and why they disallowed whatever amounts they did. Be sure you understand your coverage and benefits before you hang up. If you do not agree with their payment or determination, appeal to them to review the claim and reprocess it. They may ask you for medical documentation to support the claim before they will reconsider, but ask them what they need. If they tell you there is nothing they can do and the claim was paid appropriately, ask them what your appeal options are to get them to reconsider. You may need to write a letter and send documentation, but ask specifically where to send the letter, if there will be a case worker assigned that you can contact directly, and how long it takes for reconsideration. Be polite. Be clear. Get results.