There will always be difficult people and situations when working at a medical practice. Sometimes you just have to recognize that fact, accept it, and prepare for it.
If you have worked in healthcare very long at all, I’m sure, like me, you’ve had days that end with you saying, "I wish I was selling pecan logs at a road side stand instead of dealing with this _____today." Fill in the blank with any one of the following: patient, doctor, account, insurance company, co-worker, regulation, re-credentialing, or any of the other myriad frustrations that a healthcare worker faces on a daily basis.
There will always be difficult people and situations with which we must deal. We would be so much ahead of the game if we could just recognize that fact, accept it, and prepare for it. My favorite way of dealing with said frustrations is by trying to find the humor in it - that and by commiserating with someone going through the same trouble.
So, if you’re the type of person who finds solace in knowing that somewhere in the world someone else is also feeling like beating their head against the proverbial wall, then read on.
During my days in an orthopedic office, part of my responsibility was to come to the front office if a patient had account questions. On one such trip, I witnessed a lady giving our receptionist a hard time about having to fill out some insurance paperwork while she was waiting to be seen. The reason she was asked to fill out this paperwork is because her insurance company had sent her 10 requests already to fill it out and had denied her claim until she returned the completed form. To help her, we had the insurance company forward us the form in expectation of getting her to fill it out at her next visit and fax it for her. Hey, it was going to help us get paid and help her not have to pay the whole visit, just her copay. Win-win situation, right? Wrong!
Ms. Congeniality, apparently blinded by her fury, stomped away from the desk and didn’t see another patient in a wheelchair with the metal leg rest fully extended. She barreled toward the door, caught her shin on the fully extended leg rest, and landed spread eagle on the floor, right there in the middle of a lobby full of people who had heard her entire tirade to the receptionist. After we made sure the only injury was to her pride, we gave the form again and miraculously she filled it out with no further arguments. At the end of the day, we had a good laugh over the fact that there is still some justice in the world after all and packed away our pecan log supplies.
Recently, I found myself on hold for 20 minutes attempting to get a precert for a breast reconstruction surgery which needed to be scheduled immediately. I should have known the call was going to go horribly wrong when the response I received was: "They don’t have a phone line in that department." And with that statement, I began my newest descent into insurance phone call purgatory.
After dredging up endless life history tidbits of information, the customer service agent at ABC insurance company discovered that my patient’s employer group was covered by a sister company of theirs: XYZ insurance company. XYZ was not listed on the ID card at all, and after making mention of that fact, I was promptly told, "This department has nothing to do with the information on the card, you’ll have to take that up with XYZ company."
Call number two began with an XYZ customer service agent actually confirming that my patient was indeed covered by their plan and so I felt like I was getting somewhere. Giving the full reason for my call, however, met with another roadblock. XYZ only handles the benefits and claims for this policy; LMNOP company handles the precerts. With frustration mounting and about to overflow, I managed to politely ask for their phone number.
The third call was answered by a very capable sounding LMNOP representative named Ed who responded to my plea for help with confidant understanding. Finally, I have reached the correct person…..I could hear the Hallelujah chorus in the background! My victory dance was short lived though because once I got to the point of my request in which the question was asked "outpatient or inpatient" and I answered "outpatient," the wheels of the precert train came to a screeching halt complete with sparks flying like fireworks.
Ed informed me, "I'm sorry, but this department doesn’t handle outpatient precerts for this policy." But there was a silver lining from Ed: "Oh I can transfer you to that department. In fact I’ll send you to the nurse case manager who would actually handle the case."
After holding for about 15 minutes, my call was picked up by a sweet sounding lady who greeted me with, "XYZ insurance company, Tammy speaking, how may I help you?"
Trying to ignore the blinding flash of frustration, I was trying to quickly ascertain if I had been simply transferred to the wrong department or did this indeed mean that XYZ was the issuer of the much sought after outpatient precert. I began my request questioning if this was truly the correct department to process my request.
After all information was provided and the precert was definitely in process, I ventured to ask the question that was swirling in my now boiling frustration. My thinking is this, if they are going to waste my precious time yo-yoing me back and forth, then they are going to at least get asked the question. So I asked: "I spoke to someone at XYZ about an hour ago concerning this same request and was told XYZ didn’t handle precert requests for this policy. I’ve wasted almost two hours trying to get a precert. Why didn’t he just transfer me to you in the first place?"
She calmly responded, "That department can’t transfer calls to my department. We only take calls transferred from LMNOP company."
I hung up with a newfound knowledge of why insurance policies are so expensive - all these companies who have to stamp the ticket have to be paid somehow. I posted my notes concerning the case, cleared off my desk, and began checking the prices of shelled pecans online. Hey, a girl can dream can’t she?
Marsha Sosebeeis a certified healthcare collections specialist with over 20 years of experience in the day-to-day operations of various medical practices, including pediatrics, orthopedics, primary care, and plastic surgery. She currently manages the billing/collections department for a plastic surgery practice and surgery center in Dalton, Ga. E-mail her here.