I got seriously pissed off this evening. Looked at my health insurance account to find they had denied most of my recent claims. I had checked their website and called in advance. Every single thing I have had done was standard medical screening for a male my age.
Got on the phone to call them. First time, after waiting 10 minutes, got to a rep who said she could not help me because her system was frozen. She also could not transfer my call. So I called again. After waiting on hold, my call was routed directly to an after call survey. When I answered the survey, it asked the same question again, then said it didn't understand me (saying "zero") and hung up on me. Third time I finally got through. They said the doctor's office billed the occurrence as a standard office visit. I told them that was something which needed to be corrected between the doctor and the insurance company. Though I will be contacting the doctor's office by email. (Last time I called them, the woman on the phone couldn't find my information after telling her date date of birth twice and spelling my name three times. Guess I didn't spell it in Spanish.)
I've been in a rotten mood much of the day. Work computer and network screwing up, complete idiots on the phone. I feel my brain melting just listening to some of them. I am seriously thankful when I have someone remotely lucid call in. Too many of them think aggression will replace clinical relevance. The worse they are, the more I go into robot mode, read the scripts in front of me and include the medical standards which must be met (and which they have not met). That shuts them up most of the time. I take a different approach with nice people. Same approach but not robotic and then tell them, "This is why it's denied and this is what you need." Even though I cannot approve their request, they get off the phone not stressed out.
And then there are the ones who want to fax in 40 pages of crap from 12 years ago that has nothing to do with anything. Go ahead, fax it in and wait for someone to look at all 40 pages. You'll be waiting a while. Not my problem. When case counts matter, nobody is going to open a case with 40 pages of garbage when you know at least 38 pages will tell you nothing. Besides, you do not get paid extra for higher fax page counts in your reviews.
Any way, still holding off on nicotine but today was the roughest so far.
Got on the phone to call them. First time, after waiting 10 minutes, got to a rep who said she could not help me because her system was frozen. She also could not transfer my call. So I called again. After waiting on hold, my call was routed directly to an after call survey. When I answered the survey, it asked the same question again, then said it didn't understand me (saying "zero") and hung up on me. Third time I finally got through. They said the doctor's office billed the occurrence as a standard office visit. I told them that was something which needed to be corrected between the doctor and the insurance company. Though I will be contacting the doctor's office by email. (Last time I called them, the woman on the phone couldn't find my information after telling her date date of birth twice and spelling my name three times. Guess I didn't spell it in Spanish.)
I've been in a rotten mood much of the day. Work computer and network screwing up, complete idiots on the phone. I feel my brain melting just listening to some of them. I am seriously thankful when I have someone remotely lucid call in. Too many of them think aggression will replace clinical relevance. The worse they are, the more I go into robot mode, read the scripts in front of me and include the medical standards which must be met (and which they have not met). That shuts them up most of the time. I take a different approach with nice people. Same approach but not robotic and then tell them, "This is why it's denied and this is what you need." Even though I cannot approve their request, they get off the phone not stressed out.
And then there are the ones who want to fax in 40 pages of crap from 12 years ago that has nothing to do with anything. Go ahead, fax it in and wait for someone to look at all 40 pages. You'll be waiting a while. Not my problem. When case counts matter, nobody is going to open a case with 40 pages of garbage when you know at least 38 pages will tell you nothing. Besides, you do not get paid extra for higher fax page counts in your reviews.
Any way, still holding off on nicotine but today was the roughest so far.
No comments:
Post a Comment