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Insurance Blues
I haven't been around in.....ages, so a career update is in order. I am now a Slave for a health insurance company. Pardon: My official Title is "Company Slave, Customer Service Advocate, <Certain Hospital> Account Champion, Uptrained Too Much Too Fast and Without a Pay Raise, Dedicated rep. I pretty much ONLY take calls from people who are insured through a health system employee plan.
Now, when I was working calls for just about every type of industry known to man, we had a wide range of SCs. In my dedicated accounts, we some more "basic types".
Type 1 (and bane of my existence) Doctors.
I am very certain I could keep track of every call I take where the caller is an actual MD, PHD, DP, DC, or any other type of D. Why, you may ask? Because they are sure to drop this line at least once: "Look, I'm a doctor for <Insert Health System Name Here>. I know what I'm talking about." Listen here Mr. High'n'Mighty, you may have gone to medical school, but unless you are the only doctor in a very small practice, you have never even touched a patient's insurance card, a HICF, or a UB04, so you don't even know your end of insurance, let alone mine.
Type 2: The "And I'm adding ANOTHER hospital to the list of ones that I would rather die than be treated at".
These are the ones that are such fine products of the 'Murican educational system, that you find yourself seriously debating how this person can possibly tie their own shoes in the morning. These are the ones that you spend 20 minutes simply explaining the basic concept of how insurance works to them before you can even begin answering their questions. I would love to say that this is mostly young people, but it's not.
Type 3: The "I don't like your answer so I'm going to ask for a supervisor."
First of all, you aren't getting a supervisor. We don't even have such a position. We have managers, and they are busy managing 15-30 call reps and working the 2-5 "projects" required of them. You're getting an Escalated Call Team rep if the insurance gods love me and there is one available. If they aren't, you are getting another one of the "Sup Call Support Reps" (of which I am one) who has been with the company between 1 and 6 years. 99% of the time, we ask the CSA what they told the customer, then repeat it back to the customer verbatim. You asking for a supervisor doesn't magically change the fact that you used an out of network doctor or had a non covered service performed. It also doesn't change the fact that your employer does not care, and will not allow us to make "a one time exception" just for you.
Type 4: The "Too lazy to read". We get this gem a lot. When you have insurance, anytime they process a claim, an explanation of benefits (EOB) is generated. This EOB explains how we processed the claim, what we paid, what you owe, and what the healthcare (un)professional is obligated to write off. My company prints the words "THIS IS NOT A BILL" in all caps, larger than your name or address on this document. At least 10 times per day I hear "You people sent me this bill" or "I want to pay this bill".
Type 5: The "What do you mean you aren't a mind reader?!?"
I'm sorry, I can't tell you if the doctor your PCP wants to refer you to is In Network. Why not? Well you don't know his name or Tax ID number (the only things we can actually search for a specific doctor by). You also don't know his practice name, address, or phone number so I can't do a Google search (which technically isn't required of me). No I can't just read you the names of OB-Gyns in the area? Why? Because you live in Palm Beach, FL (the retiree capitol of the world) and we have a total of 3 hospital systems who are actual clients there. So, there are 121 Contracted OB-Gyns within 10 miles of that zip code you gave me, and the one you are looking for might not even be on my list.
Type 6: The "I'm much too busy to listen to what you're asking of me."
These ones tend to come in unvalidated, for a variety of reasons. Some of them hear the part on the system where it asks for ID number, and, not having it handy, start mashing buttons before the system can say 'or the primary account holder's social security number'. Some of them are just impatient butts who mash zero, then get mad when you aren't the person they need to talk to. Well, sir, if you had listened to the lovely computer lady, she would have said "I see you have Medical, Pharmacy, and Dental with us. Which are you calling about?" Then you could have said Pharmacy, and I wouldn't have to transfer you. Too bad for you.
Type 7: The NON Customer.
These are people who are not on the account who are calling for their mom, son, cousin, roommate, friend, neighbor, or coworker. HIPAA privacy laws make it ILLEGAL for me to discuss someone's protected Health Care Information without their permission. This means I can tell you nothing that requires me pulling up their account. Yes this means we can't talk claims. No, we can't discuss benefits either. No I can't mail you her ID card. No I can't see if that doctor is in network for her plan. Sorry.
So now that you folks have my basics, I will be sure to share some particular stories as they arise.
Now, when I was working calls for just about every type of industry known to man, we had a wide range of SCs. In my dedicated accounts, we some more "basic types".
Type 1 (and bane of my existence) Doctors.
I am very certain I could keep track of every call I take where the caller is an actual MD, PHD, DP, DC, or any other type of D. Why, you may ask? Because they are sure to drop this line at least once: "Look, I'm a doctor for <Insert Health System Name Here>. I know what I'm talking about." Listen here Mr. High'n'Mighty, you may have gone to medical school, but unless you are the only doctor in a very small practice, you have never even touched a patient's insurance card, a HICF, or a UB04, so you don't even know your end of insurance, let alone mine.
Type 2: The "And I'm adding ANOTHER hospital to the list of ones that I would rather die than be treated at".
These are the ones that are such fine products of the 'Murican educational system, that you find yourself seriously debating how this person can possibly tie their own shoes in the morning. These are the ones that you spend 20 minutes simply explaining the basic concept of how insurance works to them before you can even begin answering their questions. I would love to say that this is mostly young people, but it's not.
Type 3: The "I don't like your answer so I'm going to ask for a supervisor."
First of all, you aren't getting a supervisor. We don't even have such a position. We have managers, and they are busy managing 15-30 call reps and working the 2-5 "projects" required of them. You're getting an Escalated Call Team rep if the insurance gods love me and there is one available. If they aren't, you are getting another one of the "Sup Call Support Reps" (of which I am one) who has been with the company between 1 and 6 years. 99% of the time, we ask the CSA what they told the customer, then repeat it back to the customer verbatim. You asking for a supervisor doesn't magically change the fact that you used an out of network doctor or had a non covered service performed. It also doesn't change the fact that your employer does not care, and will not allow us to make "a one time exception" just for you.
Type 4: The "Too lazy to read". We get this gem a lot. When you have insurance, anytime they process a claim, an explanation of benefits (EOB) is generated. This EOB explains how we processed the claim, what we paid, what you owe, and what the healthcare (un)professional is obligated to write off. My company prints the words "THIS IS NOT A BILL" in all caps, larger than your name or address on this document. At least 10 times per day I hear "You people sent me this bill" or "I want to pay this bill".
Type 5: The "What do you mean you aren't a mind reader?!?"
I'm sorry, I can't tell you if the doctor your PCP wants to refer you to is In Network. Why not? Well you don't know his name or Tax ID number (the only things we can actually search for a specific doctor by). You also don't know his practice name, address, or phone number so I can't do a Google search (which technically isn't required of me). No I can't just read you the names of OB-Gyns in the area? Why? Because you live in Palm Beach, FL (the retiree capitol of the world) and we have a total of 3 hospital systems who are actual clients there. So, there are 121 Contracted OB-Gyns within 10 miles of that zip code you gave me, and the one you are looking for might not even be on my list.
Type 6: The "I'm much too busy to listen to what you're asking of me."
These ones tend to come in unvalidated, for a variety of reasons. Some of them hear the part on the system where it asks for ID number, and, not having it handy, start mashing buttons before the system can say 'or the primary account holder's social security number'. Some of them are just impatient butts who mash zero, then get mad when you aren't the person they need to talk to. Well, sir, if you had listened to the lovely computer lady, she would have said "I see you have Medical, Pharmacy, and Dental with us. Which are you calling about?" Then you could have said Pharmacy, and I wouldn't have to transfer you. Too bad for you.
Type 7: The NON Customer.
These are people who are not on the account who are calling for their mom, son, cousin, roommate, friend, neighbor, or coworker. HIPAA privacy laws make it ILLEGAL for me to discuss someone's protected Health Care Information without their permission. This means I can tell you nothing that requires me pulling up their account. Yes this means we can't talk claims. No, we can't discuss benefits either. No I can't mail you her ID card. No I can't see if that doctor is in network for her plan. Sorry.
So now that you folks have my basics, I will be sure to share some particular stories as they arise.
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