Common Frustrations With Insurance Companies and How to Cope

Even with the years of experience that our billers have, we still share some of the same frustrations with the insurance company that you most likely have. There are some widely recognized frustrations that we all seem to share, but we’ve learned some ways to cope with the hoops that insurance companies make us go through. In this article, we’ll talk about these frustrations, why the insurance company has implemented certain policies, and also how we’ve learned to cope.

Information Sharing

Why is getting information so difficult?

Insurance companies are large organizations who serve large populations. Being large in size allows them to help more people, but it can slow them down tremendously. Lots of different departments may need to communicate with each other in order to provide information. Many insurance companies have also outsourced their call centers, so the person that you are speaking with may not be in the office of the insurance company, and may only have access to specific information. Thus, you may get transferred several times before you receive information.

Additionally, insurance companies had to institute policies that are designed to protect them from fraud. These policies include things such as credentialing, re-credentialing, identity verification and security questions, and secure online portals. While this means one extra step to getting answers, it is ultimately in your best interest as well as the insurance company’s. If the insurance companies are victims of fraud to the point that they are not making money, this means that they have no funds to pay out claims.

Some information such as the fee schedule of payouts for in-network providers is proprietary, and is not meant to be shared with other providers. Because of this, insurance companies will only provide this information directly to the provider, and will need to confirm the identity of the provider before sharing. This again is something that is meant to mitigate fraud.

How to Get Information From the Insurance Company

There are several avenues that you can take to get information and questions answered from an insurance company.

• Consult documentation that has been sent to you, either by mail or by email. Pro-tip: save all emails and mail from an insurance company in a labeled folder that you can easily look through when you need information.

• If the insurance company has a provider portal, login there to access information that the insurance company has published. Portals will often contain information designated specifically for in-network providers that may not be accessible on a general website.

• Be prepared with all necessary identifying information. This includes but is not limited to NPI number, tax identification number, a provider ID number, claim reference number, patient information, etc.

• Review the insurance company’s website for an FAQ page, or if available utilize a search bar on their website. Some information that you are looking for may be public, and accessible on the company’s website.

• Keep a reference guide of phone numbers for different departments within the insurance company. Some numbers may be generic and you may need to be transferred a few times to get to the right department, but some phone numbers will get you connected with the right person swiftly.

• If you are speaking with a representative and your questions are not resolved, request a direct phone number, case reference number, or email address so that you can follow up with them or another representative.

• Be sure that emails from the insurance company are not going to spam. Make sure that they have your current email and address on file for communications.

• Subscribe to newsletters that the insurance company puts out - and be sure to read them!

Long Phone Calls

Why am I on Hold?

Insurance companies work with many providers of different types. The representatives that you speak with may not be an expert in answering all of the questions that they get presented with, and may need to consult another colleague or reference information. The call centers are also processing large volumes of calls. If you are caller number 30 and there are only 5 representatives answering calls, you may experience long wait times. We know it can be frustrating to sit and wait, so we have some suggestions below of things you can do while the hold music loops.

What to do while you’re on hold

Before calling the insurance company, identify a task on your to-do list (or several) that is quick and easy to put down when the representative returns. This way, you can accomplish things while you wait and when the representative returns the phone call can be completed quickly. Some suggestions include:

• Reading an article on industry relevant content

• Confirming that insurance information has been entered for your next patients

• Reviewing your schedule

• Cleaning out your desk drawer

• Organizing your inbox

Long Processing Times for Claims and Credentialing

What’s the hold-up?

Let’s start with credentialing. Recently, there has been an increase in volume of providers applying to be credentialed. This means that an already slow process has gotten slower. We are just as frustrated as you when it comes to the long processing times for credentialing applications. The hardest part of the whole process is waiting! It is in the best interest of the insurance company to do their due diligence and make sure that you are who you say you are on your application. You guessed it: fraud protection! Insurance companies have also likely felt some of the same strain that many businesses are currently feeling due to the impacts of Covid-19, and may have fewer employees than is needed to manage the current volume of applications.

As for claims, high volume also plays into things here. When claims are submitted, they may be adding to what is already a large pile. Things should get processed on a first come first served basis, so the volume of claims submitted can contribute to overall processing time.

When submitting claims electronically, they reach a clearinghouse before they make it to the insurance company. The clearinghouse’s job is to make sure that all information on the claim is accurate and ready for the insurance company to review - consider them a proofreader. If there are any issues, the claim will return back to you as a rejected claim and you will then need to correct any errors. This step adds a bit more time to the process, but also means that you get a second chance for information correction rather than a flat out denial because of a mistake.

If you’re not submitting claims electronically, then you are at the mercy of the US postal service, which doesn’t have the most timely of reputations. Paper claims generally take longer to process as most insurance companies have adopted more efficient electronic methods of processing claims.

What you can do to speed things up

For the most part, there isn’t much to be done once the paperwork is out of your hands and in the hands of the insurance company aside from following up. Processing time for credentialing paperwork is often projected to be several months. You may be given an estimated time frame of when your paperwork will be completed; make note of this on your calendar, and check in around then if you haven’t heard anything back yet.

For claims, processing time generally falls within the timeline of a week or two. Following up on claims can be done more promptly and regularly.

Here are some things that you can do prior to submitting applications or claims that can help speed things along:

• Before sending in your paperwork, double check all information that is being submitted. Credentialing applications should be triple checked since the information that is on the application will also need to match what is submitted on future claims.

• Make sure that your EHR is set up to send and receive electronic claims and remittances.

• Enroll in Electronic Funds Transfer (EFT) to receive your payments electronically.

• Keep an updated and accurate patient database

Would you rather not deal with these frustrations?

We hear you - that’s why we exist! If you’re sick of the long hold times, multiple call transfers, and feeling like you can’t get answers, we’re here to help. When you sign up for Practice Solutions billing services, you have a dedicated account representative who handles all of your billing for you, and even does the follow up. There are a few things that we can’t do for you, but we can at least provide you with guidance on who to contact and what to ask. If this sounds appealing to you, fill out our contact form today and a representative will reach out to you!