I just found this Sub and wanted to share one of my stories. I work at a health insurance company dealing with providers on the phones helping with claims, benefits and eligibility issues.
When in-network providers call there are a few things that they are required to get prior to calling as part of their contract with us, that way we don’t spend all day answering simple questions that they can get the answer to online, and we can services the providers calling with more complex issues. For this story the provider will be LEL (Lazy Entitled Lady).
Me: Standard Greeting
LEL: My name is LEL calling from LEL
Me: Ok, thank you, and what were you calling on today?
Me: Do you have a claim number?
LEL: No I don’t but I have the patient’s info.
Me: Ok I can work with that, please confirm HIPAA info please.
LEL: NAME,DOB,DOS, Claim Charge
Me: Ok thank you, I’ve found your claim, and how can I help you? (Up to this point she has been pretty polite, maybe rushing a bit but not to the point where I could have anything to complain with.)
LEL: Why did my claim deny?
Me: Did you check on the online portal?
LEL: No, I never do that.
Me: Well, you have to check there first, I Can’t give that to you over the phone, its part of your contract with us.
LEL: I’ve never been told that before I always get this when I call.
Me: I apologize for any inconvenience but this is how our contracts have been for years you have to check online or through the IVR first and then if you any questions I would be more than happy to help you.
LEL: This is unacceptable I want you last name, badge number and a supervisor, I have never been so disrespected in my life.
Me: I’m sorry you feel that way my last name first initial is X I don’t have a badge number to give you here is the reference number for the call, and if I get a supe they will tell you the same thing.
LEL: I don’t care just get me someone.
Me: I’m going to place you on hold while I queue up someone for you to talk to, OK?
Me:Writes up quick summary of call and gets supe on the line, get them up to speed.
Supe: I can talk to them but they have to check online first, Check back in with them and transfer them to my extension.
Me: Ok thank you for holding, I have Supe on the line she is ready to help you from here.
LEL: I just checked online and it denied for no referral and I have referral number 123456789.
Me: Do you still want Supe or do you want me to help you?
LEL: You can help me.
Me: Let me tell tell supe you don’t need them anymore first.
Me: Ok looks like that referral was set up under your old group NPI and that’s why it is not matching up correctly, if If I can have your contact info I can send that over to our referral department and they can fix that for you.
LEL: Is there anything else in need to do?
ME: No our referral department will get that fixed for you and if anything comes up they will call you.
LEL: Thanks Click