August 20, 2018

Customer Service Tools

Dealing with health insurance customer service can be a frustrating experience. Fortunately, there are ways to minimize your grief: Call early in the morning to talk to a refreshed and energetic rep. Avoid peak hours such as lunch time and the end of the day. Regardless of when you make the call, what matters most is how you approach the conversation. That’s why it’s important that you always keep a polite and friendly tone. Before you take your phone out of your pocket... take a deep breath. Try some meditation if your into that. It will help you to keep your cool. Remember, that the person on the other end is human just like you... AND they have a dump button (click) on their console and are usually ready to use it. In addition:

Prepare In Advance  Before you check the status of your claims, make sure your EOBs posting are up to date. Then make sure to have all the pertinent information in front of you, including  your account number and password, if you have one. This will speed up the verification process and allow you to focus on the conversation. Also, have your call log and a pen handy to take down important information. Try to have an idea of where the claim process went wrong and why it was mispaid: If you’re calling for multiple reasons, make a list of your objectives to ensure you don’t forget anything. In fact, it’s always a good idea to formulate your queries in advance so you can express yourself clearly and without hesitation when you deal with health insurance customer service representatives who may ask for such things as:

1. Provider's Tax ID number 
2. PTAIN (Provider Transaction Account Number) 
3. Patient's Name and Date of Birth

4. Patient's Insurance ID Number
5. Date of Service
6. Total Charge
7. Procedure rendered  

State the Purpose of Your Call  As soon as you’re greeted by a human voice, briefly explain what service you’re looking for them to perform for you today. Don’t go into details just yet. Call-center employees usually handle various types of requests, each with their own sets of procedures, so the objective here is to let the representative know which thinking cap to put on. If you’re calling for more than one reason, indicate how many queries you have and start with the most important. Only move on to the next issue once the previous matter is completely resolved.

Repeat the Representative’s Name  Representatives usually start the conversation by providing their name and their department. If they forget, don’t be shy about asking for this information, and write it down in case you need to make a complaint or do a follow-up. Note that, by law, call center employees are never required to give out their family name. Once you have the representative’s first name, the best way to deal with health insurance customer service is to casually insert it into the conversation. This seemingly friendly gesture is a threat in disguise. It indicates that you’re paying attention and that you’ll remember whom to thank or blame as the case may be.

Don't Challenge the Representative  No matter how frustrated you may feel, refrain from making disparaging or condescending remarks. No representative will help you find alternate solutions if you come off as unpleasant. By the same token, don’t rush the conversation by anticipating questions and answering them before they’re asked. It’s needlessly confusing to the representatives, who likely function better within their routine. Remember: Your goal is to get a specific service, not prove your intellectual superiority to a complete stranger. Instead, follow these simple guidelines regarding outstanding claim payments:

If the rep says that the claim "has been paid," calmly o
btain the following information:
1. Date it was processed
2. Allowed amount
3. Patient's responsibility
4. Amount of the check
5. Date of the check
6. Check payee
7. Document the phone call in your log (customer service rep's name, reference number, 
date and time you called!)  
If it is described as: "in process or pending," document the phone call (customer service rep's name, reference number, date and time you called!). If you don't see payment in 14 days, repeat the above, but more "forcefully" using the information from your call log to inform the call center supervisor of the previous representatives equivocations, outright lies, and all other manner of transgressions.
If the rep says that the status of the claim is "denied or rejected;"
1. Get more information the reason of the denial
2. Get the reference number/claim number and customer service representative's 
3. Request their policies and guidelines
4.  Document the phone call (reference#, date and time you called!)
5. Appeal the claim - if they still deny it, it is helpful to have the patient get involved with the nect stages of appeal. second level internal appeal and external review.   
Don’t Get Sidetracked  Though it’s sometimes best to let the representative control the pace of the conversation, you should always dictate its focus. When you deal with customer service, ensure the call always stays on topic. If the representative gets pushy, just say you’d feel more comfortable if your query were resolved before you discussed anything else. 
Don’t Back Down  As cliche'd as it sounds, Never take “no” for an answer when you deal with customer service. Although you may have to settle for a little less than you bargained for. Sometimes the circumstances make it impossible for you to get exactly what you want. If that’s the case, inquire about alternate solutions. Be specific in your wording; don’t shoulder the responsibility by asking what else you can do. The representative might be tempted to refer you to another department just to shift the blame. Instead, demand to know what the other options are. Make it clear that while you’re willing to be flexible, you’re still holding the representative accountable for your satisfaction.
Have the Representative Summarize the Call  This might seem like a little much, but it works: Before hanging up, make sure the representative explains what changes were made and what happens next. Get a specific time line you’ve been served . You need to know when your paid claim is effective and on what date to expect the check to be cut. Representatives usually summarize the conversation automatically, but if they forget some details, don’t be shy about reminding them. And write down this information as well as the date and time of your call. If anything goes wrong, your notes will make it easy to do a follow-up.

Be Prepared to Escalate the Issue  There’s always the off chance you’ll come across a representative who simply refuses to help you in any way. Be prepared to escalate the issue to a supervisor. Usually, they'll say, "No supervisor is available." But there’s no shame in calling again at a later date to talk to a more helpful representative. You don’t need to “win” the conversation; what’s most important is getting the specific service you’re looking for. 
The Most Important Part   If you actually can wait - I mean really wait - and you can impart that to the rep, then you stand a very good chance of getting that claim paid because the rep can't wait. Most call centers measure their employees' performance based on "average handle time" which focuses on how many calls taken per day. The more calls taken, the better the evaluation, the better the pay rate, etc. This results in the rep's worrying about how quickly they can get you off the line. So, if you can hold them up indefinitely, and they know it, what would you do to get rid of you? Agree with you and arrange to pay the claim, that's what!
Related Resources: 
1.  "Does Blue Cross Fuel Addiction by Sending Payment to Addicts Instead of Treatment Providers?, Joan Borsten, Malibu Beach Recovery Center (Feb. 2012)
2. "8 Rules For Good Customer Service", Susan Ward, (2010)

Even if it's a gag or a skit of some kind, this is some astonishingly bad customer service and well worth watching to get a read on how low the bar could theoretically be set. Even health insurance customer service doesn't match this level of abject neglect of - even malevolence towards - the customer!