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Eventually
you'll have to deal with an insurance company,
whether it's for yourself or for your parent.
There are so many insurance companies. Each one
has it's own schedule of what's covered and
what's not, what needs pre-existing
authorization and what doesn't. You can't rely
on the personnel in your doctor's office or at
the hospital to have all the answers. If you
want the straight skinny, or if you want to
resolve a problem, you'll have to take the ball
into your own hands.
The first thing you'll have to accept is that,
unless the insurance company already has written
authorization (a Release of Information or
Power
of Attorney For Health Care), you probably won't
be able to get any information about or for
another person. Privacy laws forbid the company
from giving you information about anyone except
yourself without authorization.
There are two ways to manage this if you are
calling for your parent. You can have your
parent with you when you call. Your parent will
have to give verbal permission for the customer
service agent to speak to you. Once your parent
has jumped through all the identifying hoops
(name, date of birth, Social Security number,
mother's maiden name, etc.) the agent should be
willing to answer your questions or provide the
information you called for. Once you've hung up,
if you have to call back another time your
parent will have to be with you again for the
same routine. This is unwieldy, at best.
If you can't have your parent with you when you
call, or you'd prefer to make the calls without
bothering your parent, you're probably going to
have to lay some groundwork. This may take a few
days.
Call your parent's insurance company and ask the
customer service representative where you should
send a copy of the Release of Information or
Power of Attorney document your parent signed.
Fax is fastest, of course, if you have access to
a machine. Make sure you put your parent's name,
account number, ID number, and any other
identifying information except the Social
Security number on each page of your document.
Expect to wait a week or so after you have faxed
your document for it to be filed and entered
into whatever electronic data system the
insurance company uses. If you have mailed it,
wait two weeks. Once your authorization is on
file you should be able to speak with anyone at
the company and get any kind of information you
might need.
It's frustrating to have to wait to get a
question or a bill clarified. If you have these
documents on file with the insurance company
before you need to call you will save yourself a
great deal of time. Go ahead and send them a
copy of your authorizing document now. Be sure
to put all the identifying information on every
page.
Be organized before you
call. Have a spiral notebook, steno
pad, or something self-contained where you can
keep notes of all your communication with the
insurance company. Have any documents you might
need in front of you. Have your parent's full
name, date of birth, address, Social Security
number, and insurance ID# readily available.
Expect that the call
will take a while. Don't try to call
if you only have a few minutes. Count on having
to use the keypad of your phone to enter various
numbers several times before you get to a live
person. Dialing "zero" to get out of the loop to
an operator doesn't work as well as it used to,
unfortunately. Expect to be put on hold or
transferred several times before you get to the
person best equipped to help. You may have to
give your parent's identifiers again and again.
It does no good to become exasperated. Stay
calm.
Get names.
Each time you get a new person on the line,
before you do anything else, ask for his or her
name. Write it in your notebook immediately. You
can try to get a direct telephone number, too,
in case you are disconnected, but it's rare that
you will get one.
Be clear about your
question. If you have more than one,
stay on topic with your first question until you
have either resolved it or you clearly know what
you have to do to get an answer. Take notes.
Then move on your second question, if you have
one.
Be polite, but be
assertive. If you feel like you are
being run around the flagpole you can politely
ask to speak to a supervisor. Keep this option
in reserve until you have no choice, however.
It's a truism that you will catch more flies
with honey.
Follow up.
If you need to get documents from medical
providers, or fill out a form, do so as soon as
you can. Keep copies, and keep track of when you
sent the additional information.
Stop calling.
If you can't get the information you need, or if
a problem continues to be unresolved, start
writing. There's nothing like a polite,
well-written letter, complete with dates, times
and names, to get things moving along. If you
must resort to writing a letter, include a copy
of your authorizing document (again). Don't send
it to, "To Whom It May Concern." Use the
members' handbook or the company website to get
the name of the highest level manager you can
find. This manager probably won't handle the
matter personally, but your letter will get sent
on to the proper person with instructions to
make things happen. Send your letter Registered,
Return Receipt Requested. This way you'll know
it got there, and when. I guarantee you won't be
able to read the signature of the person in the
mail room who received it, but at least you'll
know when it got into the building.
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