When people go to buy a car, they know exactly what they're paying for. They know the year, the model, how big the engine is, and most certainly how many miles they have to go before the warranty runs out.
It's not the same when people purchase a healthcare policy. Yes, they may know their deductible and co-pay, whether or not they have out of network benefits. But rarely do they know things like whether or not a DME or Orthotic falls under their usual deductible or if it falls under a completely separate deductible. By the way, most of the time DME products do fall under a separate deductible.
When it comes to health insurance even the most highly educated are at a loss of what their healthcare pays and doesn't pay. That's understandable since those that work with healthcare claims every day struggle to keep up.
Become educated about what you're paying premiums for every month. You probably know what you're spending your money on in every other aspect of your life -- your healthcare shouldn't be any different just because it's complicated.
If you don't know what your policy covers, how in the world do you know whether or not you're being billed for something you shouldn't be? You don't! If you don't know what your policy should cover and at what percentage, how can you argue when you're billed the wrong amount? You can't!
Your best weapon in getting your claims paid is to know your policy inside and out. In the long run, knowing what you're paying for every month will help you avoid paying for something you shouldn't be paying for.
Showing posts with label physicians. Show all posts
Showing posts with label physicians. Show all posts
Tuesday, November 27, 2012
Tuesday, October 30, 2012
BE A SQUEAKY WHEEL
The average amount of time that it takes for a health insurance company to re-process a claim is around 90-120 days. That's a conservative estimate if the reason that the claim is being reprocessed is complex. For more substantial issues you're looking at a minimum of 120 to 180 days. It's not uncommon for insurance companies to take as long as three years to resolve claims errors.
I could go into all the reasons that it takes that long to re-process a claim but I think I'll save that for a later date. At this stage in the game, you're probably more interested in just how to get the dang claim paid!
The first rule of getting a claim reprocessed faster is to be THE squeaky wheel. By that I mean be THE absolute number one person that they want to get rid of before everyone else! You have to get so familiar with the customer service department that they recognize your number on caller ID. Be the patient that calls every day, or at the very least every week, just to see how your claims issue is coming along. Pretty soon they'll tire of your voice and they'll push your claim through just to get rid of you because they know if they don't, you're going to call just like clockwork.
The second rule of pushing your claims issues to the forefront is to provide and obtain all the details you possibly can. You can never have too many details when it comes to getting a claim re-processed. Getting a person's name is somewhat elementary and goes without saying but it's amazing how many people don't write down the name of the person they spoke with.
It pays to go a bit further, however. Get a direct extension and the exact department from the person that is helping you with your claim. Get the name of their supervisor. Specifically request a reference number and whether or not a new claim number will be issued.
The last rule after you have all the details is to ask when you can expect the claim to be reprocessed and when they will call you back. By asking those two questions, you'll be setting an expectation up front that you're expecting accountability.
If you implement these three little rules when you call to get your claim re-processed, you can bet you'll see a quicker turnaround time in reprocessing your claims. Most likely the initial time you invest for the first claims issue will pay off for any future issues as well.
I could go into all the reasons that it takes that long to re-process a claim but I think I'll save that for a later date. At this stage in the game, you're probably more interested in just how to get the dang claim paid!
The first rule of getting a claim reprocessed faster is to be THE squeaky wheel. By that I mean be THE absolute number one person that they want to get rid of before everyone else! You have to get so familiar with the customer service department that they recognize your number on caller ID. Be the patient that calls every day, or at the very least every week, just to see how your claims issue is coming along. Pretty soon they'll tire of your voice and they'll push your claim through just to get rid of you because they know if they don't, you're going to call just like clockwork.
The second rule of pushing your claims issues to the forefront is to provide and obtain all the details you possibly can. You can never have too many details when it comes to getting a claim re-processed. Getting a person's name is somewhat elementary and goes without saying but it's amazing how many people don't write down the name of the person they spoke with.
It pays to go a bit further, however. Get a direct extension and the exact department from the person that is helping you with your claim. Get the name of their supervisor. Specifically request a reference number and whether or not a new claim number will be issued.
The last rule after you have all the details is to ask when you can expect the claim to be reprocessed and when they will call you back. By asking those two questions, you'll be setting an expectation up front that you're expecting accountability.
If you implement these three little rules when you call to get your claim re-processed, you can bet you'll see a quicker turnaround time in reprocessing your claims. Most likely the initial time you invest for the first claims issue will pay off for any future issues as well.
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