Resolving issues with health care companies are potentially trying experiences. You’ve possibly been underpaid, or are having issues pertaining to the company not authorizing necessary services. This experience doesn’t have to be a headache. The tips below can possibly avoid additional stress.
1) Be prepared for problems. Keep all records in the same place
The first step is clear. Either your claim is accepted, or there is trouble ahead. In the United States there are several billion claims processed each year. Health insurance companies are no different than anyone else; they too make mistakes.
Keeping records of all contacts you have with insurers within easy access can help. Each contract, fee schedule, addendum to a contract and letter referring to a contract or other payment matters should be filed together, or at least have one folder for each of the individual insurers.
2) Ask for clarification
If you are in the middle of disputing actions taken by the insurance company, you need to understand why this action is being taken. There are trends towards policies and positions. In some cases there really is no clear explanation for any action. For example, you may want them to give you a fee schedule, but they won’t tell you why you can’t have one. In these types of situations, don’t hesitate to put a little pressure on the company to at least get some answers.
3) Relevant information
If the company cites an article in your contract, it’s time to review the section. If you don’t have your own copy of the contract, ask for one. It’s also important for you to consider any documentation you have which supports your personal position, and make each section or citation known to the person you are speaking to.
4) Start cordially, and then escalate
Start the conversation or email as calmly as possible. If your polite and courteous approach doesn’t produce results, you can gradually become more assertive. Keeping your tone at a cordial level is even more appropriate if you have any type of established relationship with the company representative.
5) Paper trails
Keep track of all conversations including time, date and who you spoke with. Write a short summary of each conversation, keeping this with your other files in case you need it later.
If your cordial measures don’t resolve the situation, it’s time to build on that paper trail. Start putting all communications in writing either via email or registered letter.
6) Short and sweet
Insurance company employees normally have large volumes of calls and paperwork each day. They aren’t likely to have time to wade through page upon page of information on a problem or issue you are having. Keep your communications short and to the point so they can find what they need easily.
7) Make yourself clear
Keep in mind that you aren’t just stating a complaint, you also need to be clear in what exactly it is you want the company to do for you. What’s the action you need from them? Do you need them to answer a question? Authorize required care or maybe pay a claim? Even though this is often overlooked, it’s a vital step in getting your issue resolved quickly.
Climb the chain of command
It’s possible your initial contact isn’t very helpful to you. Don’t hesitate to ask for the name and number of the next in command. Ask for the information politely, and say they may have a better knowledge of how to deal with this particular type of situation, or have different authorities than a lower level employee may not have.
9) Be persistent!
If at first you don’t succeed, keep trying. Just because you got a negative response the first time, doesn’t mean the case is closed. Being persistent shows the company you are not willing to let them sweep your case under the rug. Keeping on top of things means that you are also keeping the insurance company’s employees on their toes.