Pre-Operative Administrative Observations

Jul 02, 2010

This past week or so has been very interesting in terms of the process of (i) gathering all documents for insurance approval and (ii) getting all pre-operative testing conducted. I want to lay out a few observations in hopes that they might assist others in the process:

1. Go into this experience with the mindset that you are your own advocate. A few tips:

a. Assume that all front office staff  -- receptionists, surgery schedulers, insurance coordinators -- are, at best, incredibly busy and, at worst, utterly incompetent. Do not rely on them to get your paperwork processed in an efficient and effective fashion. 

b. Assume control over the process: (i) take detailed notes -- always get the names and contact information for everyone you speak with. (ii) print and keep a detailed monthly calendar that shows the days on which your tests are scheduled. (iii) buy a large file folder to keep all of your records in and always have it with you. You will make calls from everywhere and you will need it with you at every appointment.

c. Neither be afraid to or shy about calling any physician's office as many times as you need to get your questions answered. My surgeon's front office staff did not return a series of messages from me. I typed a one page memo and faxed it to the office on a continuous loop for three hours! I set the automated fax feature of my machine and left and went to work. Suffice it to say that I received a call addressing my concerns. It seems like overkill but this is YOUR life on the line here. 

2. Understand the difference between insurance requirements and pre-operative requirements. Many of these insurance coordinators and surgical schedulers want to wait until you have every PRE-OPERATIVE test conducted before submitting for insurance approval. I posit that this is inefficient. Go ahead and submit what you need for INSURANCE APPROVAL as soon as possible so that you can receive that. Pre-operative testing can continue while you submit for insurance approval. They are two related work streams that, when conducted efficiently, have logical points of intersect. Office staff, though, will see this as extra work. Let them know that you understand the process and request that they submit for insurance approval as quickly as possible. ANTICIPATE push back; they will tell you that this is what they do for a living and that they know the ins and outs -- respond politely that you appreciate their knowledge and move on. Remember this is ultimately a business for them ... do not get tied up in emotional knots. 

3. Do your part -- go to your appointments, do not miss them. Do all of what you are supposed to do. You have to exemplary through this process. You will be called to the carpet if not.

4. Read, read, read --- all your documentation ... make certain that you understand the insurance and schedule aspects of this process. Ask questions about anything that you don't understand. Do not be shy about ASKING QUESTIONS.

OK -- that's it.

0 Comments