On The Job with Healthcare

[rebeccajo 14]

I am, at this very moment, at work - verifying insurance coverage for a patient seeking care.

I just got off the phone with a health insurance company. After navigating the computerized call screener with our tax ID number; the patients ID number, and the patients SS number I was permitted access to a Human. The Human Christy asked me my name and my call back number and the patient ID number. The Human Christy ascertained that the policy had termed 12/09 because coverage had been transferred to another company. The Human Christy then transferred me to Bobbie at the new company, who asked me my name and my call back number and the patient ID number and informed me the mental health coverage was handled in Philidephia. She transferred me to the Human Jeffrey who asked me my name, call back number, patient ID number and then informed me the benefits were handled by a special unit in Philadelphia. The Human Jeffrey transferred me to Samantha who asked me my name, call back number and patient ID number - I can't even remember now why Samantha transferred me to another Human named Shane. Shane asked me my name, my call back number and my ID number.

Shane was then able to tell me the effective date of the members coverage; how many visits per year they are permitted and the co-pay amount. Shane informed me there was no deductible but a $4000 out of pocket limit. Shane informed me that the patient's PCP must send them a MDIPA referral form for the patient to get their maximum benefits. After the PCP has sent the form, I am to wait 3 business days after which time I can ring back another phone number and obtain authorization for services.

This took 22 minutes and 21 seconds. I now have to ring back the PCP and tell them what they must do for the patient to get their coverage. I will wait three days and then spend probably another 20 minutes getting authorization.

Edited September 4, 2009 by rebeccajo

[rebeccajo 14]

I have just called a second company.

After passing through the computerized call screener with tax ID; patient ID and patient birthdate I was routed to a call center in Argentina to speak to a Human named Lynn. Lynn asked me my name, call back number and patient ID number.

I was informed the benefit is 30 visits per year with a $20 co pay, no applicable deductibles or out of pocket limits. Pre-certification of services is required. Lynn is unable to transfer me but provides me with another phone number to call for pre-cert.

This call took 8 minutes 29 seconds.

I dialed the second number, passed through the call screener to a Human named Carolyn in the United States. Carolyn asked me my name, call back number and the patient ID number, patient name and date of birth. She asked the name and educational credentials of the person performing the services. She placed me on hold. When she returned she gave me an authorization for services good through 12/31/09.

This call took 10 minutes 48 seconds.

[Mr. Big Dog 10,747]

See, this is why this is the best health care system in the world: it employs so many people. All over the world, apparently.

[Joseph & Ana 0]

Thanks for the play by play at your job. I'm working on cost-down items. It will take me 4.5 hours more approximately.

[rebeccajo 14]

Third call.

4 minutes and 50 seconds to get past the computerized screener. The Human named Kimberly informed me the benefits I am requesting are carved out to another company. She transfers me to the Human named Jamie.

It's helpful to note that each time I am transferred (with any company) I must repeat all the information I put into the computerized screener.

The Human Jamie helps me figure out that we are out-of-network for this patient. I also have only a handful of clinicians who can serve this patient. Out of network benefits are no co-pay but instead a 60/40 cost share with a $1000 deductible.

Total time for this call - 15 minutes 45 seconds.

See, this is why this is the best health care system in the world: it employs so many people. All over the world, apparently.

I get frustrated with the time it takes to verify the coverage. And it's an appropriate point because it indicates the waste in the system. But there is another more important point.

Take a look at the differences in coverage.

[reeses16 8]

Wow.... That's ridiculous! I am totally fed up with the system the way it is. Bills that arrive 4-5 months after service, with errors that take 4-5 months to correct.

[rebeccajo 14]

Fourth call.

Total time 7 minutes 15 seconds. Computerized screener and one Human named Kristen.

Benefits are 20 visit per year limit. No copays. No deductibles. No out of pocket. Covered at 100%.

Extremely rare cadillac coverage.

If all the beneifts were like this I wouldn't mind how long I have to hold for my patients.

[rebeccajo 14]

Fifth call.

8 minutes 39 seconds (4 minutes and 43 seconds to get past computerized screener). One Human named Angel.

Benefits are 80/20, 30 visits per calendar year, $250 deductible, $2K out of pocket.

We are in-network but again with only a few clinicians who can serve the client (not a widely used plan in this area). Limits the 'choice' the patient thinks they have.

Edited September 4, 2009 by rebeccajo

[rebeccajo 14]

Sixth call. 6 minutes 59 seconds. Computerized screener and one Human.

45 visits per year maximum. $20 co-pay. First five visits are free. No deductibles or out of pocket limits for in-network providers (which we are - this is a widely used plan - lots of choices for the patient).

Really good coverage.

[rebeccajo 14]

Seventh Call.

This is the local Big Blue.

Easy peasy computer screener and one Human named Robin. Total time on the call 6 minutes 41 seconds.

Coverage 80/20 after a $100 deductible. Out of pocket does not apply. Treatments are based upon medical necessity - a treatment plan is required after the ninth visit in order for the patient to obtain other services.

Widely held plan in this area - lots of choices for the patient.

Going to lunch now. I won't make any other insurance calls today unless it's an emergency situation. Other tasks to do this afternoon.

Edited September 4, 2009 by rebeccajo

[Y's_habibitk 2]

welcome to insurance verification and authorization... thats why I could never have that type of job, how miserable to spend your whole day repeating the same info over and over and being transferred 8000 times. It's all so productive isnt it? Although most major insurance companies have had eligibility and benefit info available online for years now.

[The Dude 206]

Wow, these people with this insurance seem quite shady. Real americans have good health insurance that doesn't require any of that.

[rebeccajo 14]

welcome to insurance verification and authorization... thats why I could never have that type of job, how miserable to spend your whole day repeating the same info over and over and being transferred 8000 times. It's all so productive isnt it? Although most major insurance companies have had eligibility and benefit info available online for years now.

My employer requires a verbal verification in case we have to dispute a claim.

[Mr. Big Dog 10,747]

welcome to insurance verification and authorization... thats why I could never have that type of job, how miserable to spend your whole day repeating the same info over and over and being transferred 8000 times. It's all so productive isnt it? Although most major insurance companies have had eligibility and benefit info available online for years now.

My employer requires a verbal verification in case we have to dispute a claim.

How much time do you spend on verifying coverage and eligibility for Medicare patients?

[rebeccajo 14]

welcome to insurance verification and authorization... thats why I could never have that type of job, how miserable to spend your whole day repeating the same info over and over and being transferred 8000 times. It's all so productive isnt it? Although most major insurance companies have had eligibility and benefit info available online for years now.

My employer requires a verbal verification in case we have to dispute a claim.

How much time do you spend on verifying coverage and eligibility for Medicare patients?

None. We just schedule them in for an appointment.

Unless they have a Medicare Advantage Plan or a Medicare Crossover Plan.