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Momofevan

Dealing with insurance companies

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I am constantly fighting with the insurance companies to get them to approve tests, procedures. Any advice?

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Hello there and welcome! 

Yes, the insurance is hard to deal with, we already have so much on our plates!  Until the treatment plan gets cranking it’s a battle. So here are some ideas:

1. You will need to enlist the assistance of Human Resources, find out which company has the financial responsibility for managing the claims. If it’s the employer, then they are self insured. The HR department will have an insurance advocate to fight the battles.  If the health plan manages the claims then you will need to file an appeal if anything has been denied. It’s more typical to see delays than denials. 

2. If there are serious issues with the insurance company, you can file a complaint with the state department of insurance. 

3. Meet with the hospital financial team to find out what the issue is.  Sometimes it’s the Hospital system that is slow in getting requested medical records.  Sometimes the hospital has a “utilization review” nurse to manage the pre-certification process. 

4. Enlist the help of the hospital patient advocate- half of my insurance issues in the beginning was due to poor documentation from the hospital finance team (my doctors documentation was perfect! )

5. Eliminate the word “waiting for a call back”. You will need to be assertive as the squeaky wheel gets the grease. 

6. Do not sign any hospital financial papers accepting liability until the insurance issues have been sorted out. 

7. Create a log and document everything, dates, times and names (first and last)  somehow insurance companies have become allergic to sharing last names! 

Hopefully this general feedback is helpful.  Let us know any specific questions and if needed. 

Michelle 

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