From time to time, all of us must call our health insurance company for one reason or another. I cannot emphasize enough how important it is for you to keep detailed notes of any conversation you have with your insurance carrier. Perhaps you are calling to determine the status of a health insurance claim, or you wish to appeal a claim because you feel that it was not processed correctly or they should have paid more money. Maybe you have a question about your premium, or if you have an HMO, you may wish to change your primary care physician. Perhaps you are calling for pre-certification or pre-approval before you are admitted to a hospital or have a certain surgical procedure done.
If you are the insured or you are the billing secretary or the insurance clerk in a physician’s office, this information is relevant to you. When you call, write down the date, be sure to get the name of the person with whom you spoke, their title, and what department they are in. Write down the details of the phone conversation, and then keep this information in a safe place where you will be able to find it if and when you need to follow up again.
If you are calling because you paid the premium and they did not give you credit for it, it will be your responsibility to prove that you did pay the premium. A canceled check is always your best proof, but you must send a copy of it to the correct department, so detailed record keeping and the name of the person you spoke with and their instructions will help validate the situation. Most insurance plans, except the traditional Medicare program, require pre-authorization for a hospital admission, surgery, and even same day surgical procedures or invasive testing. It is always best if the physician’s office calls for the pre-approval or pre-authorization. The physician’s office will then notify you that your insurance company has approved your admission or surgery or whatever the case may be. I then recommend that you call the 800 number, that should be somewhere on your I.D. card, and ascertain that this has indeed been approved. Be sure to get the name of the person you speak with and their title and write it down and put it in your medical file folder. You don’t want to find out after the fact that you are not really authorized to have the work done. It will then be your responsibility to pay the claim out of your pocket or benefits may be dramatically reduced.
If you have an HMO, or an HMO with a Point of Service option, you must choose a primary care physician. Your primary care physician will coordinate all of your medical care and make referrals to other specialists as needed. You do have the right to change your primary care physician, but you must notify your insurance company that you wish to do so. When you call the insurance company to notify them that you are changing your primary care physician, be very specific. Mention the name and Social Security number of each person in your family for whom you are making the change. Be sure to write down the name of the person that took the phone call, the date you called and the time and what the comments wereUnfortunately, all of this managed care paperwork is increasing the overhead in a physician’s office and placing a tremendous burden on a staff. There are days when they simply do not have the time to check the PCP list and the bottom line is, it is still the responsibility of the patient to inform the doctor’s office of his/her health insurance. If this patient had taken notes when he called and with whom he spoke and how the conversation went, he would not be in the mess that he is in now.
In summation, regardless of the reason for calling the insurance company, record the date, the time, the name of the person with whom you spoke, their department in the insurance company and their title. And then record detailed notes of the conversation. You should have a file folder for your medical bills and place this pad or sheet of paper in that folder so that you will be able to find it when you need it.
Irene Card & Betsy Chandler share the responsibilities of running Medical Insurance
Claims, Inc. a health insurance services company. If you have questions relative to this
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