Making your insurance customer service calls more pleasant

by Cheryl Baumgartner Medical Billing/Coding/Insurance

I have spent the last several years working customer service; and it's not an easy job. Your day is spent interacting with different people and handling their different problems. dealing with a call center can be frustrating; but there are little things that you can do to make your interaction more pleasant and efficient.

1. Have all your necessary information on hand-when you call in to customer service have everything you need such as account number, invoices and bills easily available. It's not unusual to have to hold. If you have all the information at hand, it allows the representative to address and solve your issue faster which cuts down on the time it takes to handle your call. That translates to a lower hold time overall.

2. More complex issues may take time to solve-A complex issue may take calls to a different department or even a third party. Your representative will make every effort to affect a 'first call resolution'; but that may not be possible. If they offer you a call back; the purpose is not to ignore your issue-but to respect your time.

3. Ask for a supervisor when it's necessary and not because you don't like the answer you're being given-Your representative may give you an answer that is not what you want to hear; it's because they are giving you an answer based on documentation outlining your benefits. Your benefits documents outline what you are covered for and what you are not covered for.

4. Abusing your representative verbally is not going to magically give you the result you want-Yelling and/or cursing at your representative accomplishes nothing. Believe me, those of us on the other end of the line understand your frustration. The person you are speaking with has to deal with angry and frustrated customers all the time and we understand that everyone can have one of those days. Stop take a moment and collect yourself; the last thing you want is to be 'that' caller. Repeat callers who conduct themselves in that manner over time do get noticed and companies will flag your account.

5. Do your due diligence-Read your benefits documents when you get them. and check your insurance cards as soon as you receive them. The two most common issues are going to be disregarding the rules of your coverage and having the wrong doctor assigned. Know if you need referrals or pre-authorizations before you go see that specialist. Once you have generated a denied claimed for not having a referral; you are responsible to pay out of your own pocket. while you can file an appeal with your insurance; the appeal is based on your benefit documentation.

As for the assigned doctor issue. reaching out to your insurance as soon as possible allows for your doctor to updated in a timely manner. Calling the day before your appointment is usually not going to result in the doctor being changed immediately. Even a retroactive doctor change isn't a guarantee that your doctor will be updated to be effective before your appointment.

6. Establish yourself with your doctor as soon as possible-Your doctor is not your doctor until you have a new patient appointment and establish yourself with his practice. This is extremely important. Doctors' availability is determined by their panel status which can change month to month. There are four general panel statuses-Accepting all patients, accepting existing patients, closed, and termed.

Closed and termed means that the provider will not be available to accept you at all. Existing patients means that if you are established as a patient with the practice then you will be accepted. Keep in mind that established patient is not permanent; you still have to see the doctor at regular intervals to maintain your established status. Accepting all patients is self-explanatory. If you are not established and have an issue; the office does not have to accept you.

These six things can make things much easier when calling about your insurance. if you have the information we need and have followed your benefits requirements; then you representative can quickly and efficiently discover your problem, research options to address your problem, and implement a course of action to solve it. This means you will be serviced quicker and with much less stress.