Facing the required phone calls often necessary to insurance companies may be the worst part of the day for medical office staff. It is time-consuming and can be very frustrating at times. Being prepared and remembering a few tips while on the phone can save time and sanity.
Gather the patient information including the chart, claims and Explanation of Benefits. Keep a list of all physician information handy including National Provider Identifier (NPI), tax identification number, and if you are calling Medicare or Medicaid, you will need the provider numbers they have assigned, plus office phone, fax, and mailing address. Find a quiet place without interruptions.
Before calling the insurance company, write a few notes regarding the questions you are asking. As you work your way through the insurance company phone system, choose to enter the information by keypad instead of speaking, if you have the option. There are very few phone systems that correctly identify every spoken answer and this can add to the frustration level from the very beginning.
When you get a customer service representative, write down their name and answer any questions they have for you first before launching into the issue or problem. If for any reason you cannot understand the representative, make sure and ask them to speak up, speak slowly, or transfer you to another representative. Try to make your own speech clear and loud enough for them as well.
It helps to be kind and keep your tone moderate because your representative is a human being with a life outside of their job, just as you are. I often try to picture the person I am speaking with, and smiling while on the phone can help you stay friendly also. If I get on the phone with a representative who does not understand my question or gives me information that will not solve my problem, I apologize for being hard to understand and ask for another representative to speak with.
Insider note: most of the customer representatives I knew in a health insurance company had never processed a claim before, so do not be dismayed if they seem to know less than you about claims processing. They probably do know less, but they are trying to help. Be patient and explain your dilemma in as simple and as clear terms as possible.
There have been times when a customer service representative is less than accommodating with me and seems frustrated with my persistence (be persistent in getting the explanation you want!). It is good to end these call with a ‘thank you’ and call back immediately to speak with another representative. The more patience you can show, the more the representative will want to help you. Professionalism is a key word in dealing with people we never meet but have contact with, whether on the phone, by e-mail, or other correspondence. And like the Boy Scouts’ motto, “Be Prepared.”
As I was looking over notes last week and prepared to call an insurance company, I noticed the representative I last spoke with was “Jenn.” When I called the same company, I was delighted to find myself speaking with “Jenn” once again, and mentioned we had spoken the week before. She said, “I thought I recognized your name and your voice” and the rapport was established with just that small bit of information.