Vent about insurance coordinator/dealing with office staff?

How do/did you light a fire under your insurance coordinator? I have faxed in my denial letter to my doc's office as directed and....nothing. OK, last week was still the holidays so I was patient last week. I left a message on the coord's voice mail yesterday morning. Later, I got a return call from someone in the office: "um, hi, we received a call from this number?" How odd! I told them why I was calling and she said she would have the coord call me back before the end of the day. Nothing.

I am not having the warm fuzzies about this office at the moment. Even though they are some distance from home, I am half tempted to go park in their waiting room until I can talk to her.

I know this is WAY more important to me than it is to them. I am sure they are busy, but my request is simple: please give me INFO about the appeal we are going to launch. What are they going to do? What do I need to do/what do they need from me? And, one question I still don't have answered from the first submission: can we please make sure that the documentation that goes in is complete as possible to prevent ANOTHER denial? And what is the timeframe we are talking about here? C'mon guys, let's get moving.

Seriously, I am aggravated enough that I am considering switching practices. If they can't get my paperwork straight, how are they going to get ME straight? My confidence is waning.

What have you all done in similar situations? Is this level of office chaos normal? Anybody switched practices midstream? How did that work for you?

If you haven't tried this yet - go by the office in person - and speak to someone in person like your gut tells you! 

I wouldn't switch quite yet.  Nothing wrong with advocating for yourself!  Go for it and good luck.

I'm the GM for a MRI company.  If any of my staff behaved in this manner, I would fire them...

Call and ask for the Office Manager and voice your complaint.  If someone doesn't' tell the manager there is a problem, he/she may not have any idea. 

Good luck!!

 

 

As someone who also works on the other side of health care, yes, people get busy and buried under several requests.  However, there is no excuse for not calling you back and at least saying "I don't have an answer for you yet, but I'm working on it and hope to know something by ____.".  

My advice, before you haul yourself into the office, is to call the office again and ask for the coordinators email address.  Send her a firmly worded email.  Not angry, just firm.  Be as brief and concise as possible,  Then end it with saying "I appreciate that you are very busy and appreciate you giving this matter your prompt attention."  (getting more flies with honey....yadda yadda).

Hope to hear good news from you soon!

I second the firm email. My surgeon's insurance coordinator is a big sack of stupid. I eventually contacted my insurance company, spoke with the review nurse, clarified the information, and then contacted the surgeon's office. I also logged on to the insurance website and read the policy. Educate yourself on your insurance company's process. Do not take anyone's word for it; look it up and read it yourself. Copy it and forward in an email if necessary. As irritating as it is to have to do someone's job (and discover you are far better at it), sometimes that is the only way to get anything done.

good luck

Thanks, everyone. We spent today playing phone tag. We will see what tomorrow brings. My meeting schedule is much lighter tomorrow so hopefully we'll have some resolution.

Red flag #1: My policy requires BMI of 40 for approval:

• ME, at the first surgical consult: It doesn't have anything on my policy about the comorbidity clause for >35BMI.
• HER: It's ok, they follow the 35 + comorbidities guidelines.
• ME: Do we need to include any explanation about how I have been on a physician supervised weight loss program on and off since 2008, putting me barely below a BMI of 40?
• HER: No, we'll just send it in. It'll be ok.

Red flag #2 is how they went radio silence on this whole topic. I hope I have a productive conversation with her tomorrow. My schedule is light so I may do the in-person visit approach if I don't hear from her in the morning. A strongly worded email and call to the office manager will come also tomorrow if I don't get to talk to her.

I find myself wondering why I rushed around to get the prereqs done by 12/15 if they're being so *$#% leisurely about it now.

What sorts of things go into an appeal packet? Is there a specific format? Heck, I will write it myself if need be.

The fact that I got a denial isn't bothering me (anymore). The fact that I feel as if I am at the mercy of a person/process who is 1) black box on what is going on and 2) doesn't seem to care that this is in limbo is what is bothering me.

Thanks for listening, all!

Hang in there and keep pushing! 

You should have received info with your denial on how to appeal.  If not-Contact your insurance and they will provide you the info.  AND do NOT accept NO as an answer.

If you do a search on here you will find sample letters of appeals!!

Thank you. I will keep pushing. I sent the strongly worded email today and cc'ed the office manager when I didn't get a call back, even after I left a message this afternoon. 

Next step: camping out in person on Friday if need be, if for no other reason than to get my medical records and start the transfer process.

Hard not to be discouraged. Frustrated as hell at the moment. I am kicking myself because I gave the surgeon's office a full copy of my medical records - I usually tell them to make a copy and give me the originals back. Now I have to go track down my records again so I can cite facts and figures.