Managing Your Managed Care

The information in this chapter if applied could mean the difference between success and failure in the health insurance world. I learned this valuable aid by working at Blue Cross and Blue Shield where it was stressed to have proper documentation on every call. This serves as legal documentation for the insurance companies, but the concept can be applied to any facet of life. Credibility is established when names, titles and phone numbers can be verified. It makes sense to write down the names of whom you are dealing with and talking to from the doctor’s office, the insurance company and the billing service office. Take the time to get last names or initials and phone extensions in case more than one person works at a company with the same first name.

I recommend getting a notebook or calendar especially for dealing with insurance, doctor appointments and medical bills. Make it small enough to take with you everywhere you go, because I talk to people everyday who say “ I got this bill, but I left the information at home and I am work now” and there is a limit to what the customer service area can do for them.

An educated insurance consumer keeps track of their appointment dates, the people they speak to and the doctors they see. You do not want to call your insurance company and say, “I saw a doctor in the medical Group of St. Williams Hospital sometime last year and now I am getting a bill. I don’t know the doctor’s name and I don’t remember what date I was there. I think it was in the spring but I can’t be sure and I need you to tell me why this bill was not paid.” You need to know something about your medical services when calling to ask for help. We have computers that can help us track the claim, but that may take a while if you have no information. Please don’t be narcissistic when calling and assume that we know what you are taking about and that have your whole call and claim history up on the computer and can immediately find the claim in question. Most companies have ways of tracking calls, but it does take some probing or some information from you to get the issue resolved.

Do you have the claim?” Your insurance customer service representative will be in a better position to help you if you have your ducks in a row, so keep a calendar or appointment book which tracks all this information.

If it has been 30 days since a doctor or hospital visit and you have not received a bill and or a claim explanation from your insurance company, call the medical provider since they are the ones who can send you to collection if the bill is not paid. Find out the date the claim was filed to insurance and who filed the claim. Take the time to make sure they have all the filing information correct and that they have a current copy of your insurance card(s).