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Monday, March 7, 2011

Dealing with Insurace Company Phone Reps

As a PWD (person with diabetes), I rely on having insurance to cover most of my medical bills.  And by rely, I mean I expect certain things to go off without a hitch.  Like getting pre-certification for physical therapy, for example. 

My initial visit with my physical therapist was what was called a "diagnosis/recommended therapy" visit.  This means that my physical therapist (PT) took a look at my knee, how I walked, and muscle structure and submitted a recommendation to my insurance company of what kind of therapy I needed.  Said insurance company then receives the recommendation and submits a pre-certification back to my PT for said therapy.  This process, in ideal theory, should take a business day (two at most) to get done, especially when you're expected to get 3 sessions of therapy a week for 4 weeks before the next orthopedic appointment in 6 weeks. 

But . . .

Unless you stay on top of the insurance company like a rabid zombie gnawing on their neck, this process could take 2 weeks if left unattended.  The initial call to my insurance company from my PT resulted in them telling my PT that this process would take 4 business days.  This was somewhat annoying because it meant I was going to miss half a week of therapy (2 sessions) before I could come back.  Well, 4 days come and go and my PT's office calls my insurance company again, inquiring about the pre-cert. and the very vague just-trying-to-get-you-off-the-phone answer was given, "It's in process."  I hate getting this answer from anyone!  Where in the "process" is it?  How much longer should I expect to wait?  Why would you give a timeline of 4 business days, miss the deadline without notifying us, and cease to apologize?  It's absolutely a slap in the face to say "It's in process"!

So my PT's office calls me to let me know that I would have to cancel another schedule therapy session because they were still waiting on my pre-certification.  I had turned from annoyed to infuriated.  Being the very involved patient that I am, I asked for the number of the authorization office to take this matter in my own hand.  I prepared myself for the inevitable bad mood that was about to follow this phone call, but luckily this comic strip gave me a giggle. 

I called the number, went through the voice-automated responses (several times I got "I'm sorry, I didn't catch that."  Well, learn the Southern dialect Ms. Stick-up-your-butt Robot!) until I finally got a real person, in some department.  I didn't really care which department, I just wanted a live person!  Now, what irks me about calling any customer representative department is that they ask you several questions before you can even begin to ask yours. 

Below is an (exaggerated) retelling of the phone call to my insurance company customer service number:   

CR rep:  "Hello, this is Monica (names have been changed to protect the guilty), can I have your name, address, member ID number, and blood of your first born child?" 

Me:  "Ummm, my name is Holly, my address is . . . , my member ID number is . . . , and I currently don't have any children, would the blood of one of my cats do?" 

CR rep:  "Certainly!  What can I help you with?" 

Me:  "Well, I've been waiting on a pre-certification for physical therapy that my orthopedist recommended for me, and it's been 4 business days since my PT's office called for that.  Where is it?" 

CR rep:  "Let me see . . . *clickity click click* . . . hmmm, I don't see where that request was made." 

Me:  "No, it's there.  I just got off the phone with them, please look again." 

CR rep:  *clickity click click* . . . Ahhh, yes, there it is.  I just had actually LOOK at the computer!  Haha, silly me.  Yes, it appears the request is in process (grrrr!!!) and it usually takes 7-10 business days to fulfill this request." 

Me:  "7-10 business days?!  My PT's office was told 4, why is it taking so long?" 

CR rep:  "I don't have that information in front of me, that would be with the Authorizations Office." 

Me:  "Well, can you transfer me to them, please?" 

CR rep:  "Oh no, they don't deal with members directly, they only deal with providers." 

Me:  "Well, can you transfer me anyway?  My provider has tried calling several times already." 

CR rep:  "I can see.  Please hold." 

*really bad elevator music plays*

CR rep:  "Yes, I'm sorry, they won't talk to members directly, they only deal with providers." 

Me:  "Yeah, I don't care, I still want to be transferred and let them know that my provider is waiting for it." 

CR rep:  "OK, but they won't want to talk to you." 

Me:  "I don't care, they're GOING to talk to me.  Please transfer me." 

CR rep:  " . . . Please hold." 

*extremely bad elevator music plays* 

AO rep:  "This is Jennifer, can I have your name, address, member ID, and left ovary please?"

Me:  "Left ovary?  Why?" 

AO rep:  "Standard procedure, ma'am." 

Me:  "Ummm, OK.  I am calling about a pre-certification for physical therapy.  I was told it is in process, but I was wondering if there was any way to speed the 'process' so I don't miss physical therapy." 

AO rep:  *clickity click click*  "I'm sorry, that request is not here." 

Me:  "No it is there, the person I talk to before you said it was.  Please check again." 

AO rep:  *click*  "I'm sorry, it's still not here.  You need to have your doctor call to request it." 

Me:  "He HAS requested it!  It is there!  Please.  Check.  Again." 

AO rep:  "I'm sorry, ma'am.  It's not there.  I have looked."  *click* 

Me:  "Hello?  HELLO?!  Son of a . . . !!!"

Yes, I was hung up on, by MY insurance company rep.  I was fuming!  This company is there to serve me!  I am their customer, and they practically spat in my face!  I was never rude or cussed, I just kept asking for answers to my problem that no one could give me.  But I learned a few things about getting some results out of dealing with calling your insurance rep: 

  • Be polite, but firm.  I never cussed or raised my voice.  I always ended everything in "please" and "thank you".  This gives them no reason to refuse your request. 
  • Refuse to end the call until you receive an answer.  I didn't care if I would eventually be transferred to the head of the company, I was going to talk to someone until a) this matter was resolved or b) 5:00 PM, whichever came first. 
  • Have your insurance card handy.  By the end of the call, I about had my member ID memorized.  
  • Be patient.  I'm saying this to myself as well, but I refused to let another day go by without an answer.  
My PT's office called me this morning at 9:00 AM and told me that the pre-certification had come in.  "I don't know if it had to do with you calling them, but we got what we needed!"  Oh, I'd like to think that I DID have something to do with it.  ;-)  

4 comments:

  1. "The Oatmeal" is AWEsome!
    You do need to figure out how to record one of those calls. :-D

    SO glad things worked out for you. Good luck with your PT.

    ReplyDelete
  2. I'm so glad you got what you needed. Persistence pays!

    ReplyDelete
  3. Persistence and politeness do pay out, eventually. It took me 9 phone calls between the provider and insurer to get my last order of pump supplies.

    ReplyDelete
  4. Lol, oh holly. I'm so glad that you got it figured out! This post was hilarious and right on the money. :)

    ReplyDelete

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DISCLAIMER: I am not a doctor, nurse, certified diabetes educator (CDE) or any medical professional of any kind. (But I did stay at a Holiday Inn Express!) Therefore, please do not use any of my postings as medical fact. I am simply a blogger expressing my highs and lows (pun intended) with diabetes. For changes in your medication, exercise regiment, or diet please consult a qualified physician.

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My name is Holly and I live in north Alabama with my hubby, two cats, and a dog.