Author Topic: recording telephone conversations  (Read 3887 times)

ste

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recording telephone conversations
« on: September 14, 2012, 07:35:59 PM »
I have a potential client who would like to see me record telephone conversations during benefit verifications. The client seems willing to give me a lot of business, but still I am reluctant to record phone calls. A previous biller who is now retiring would record calls and at one point was able to sway an appeal in her favor after playing a recorded phone call showing benefits being misquoted. The physician was thrilled.
In my relatively short period of experience I've always lost these types of misquoted benefit appeals (a total of about 2). The insurance never has a problem with admitting giving me misinformation. However the insurance will stand behind their disclaimer that quoted benefits are not a guarantee of payment... And the appeal is denied. So, I just don't see the point behind recording phone conversations.
Anyway, my question is:
Is it legal to record such phone calls? And are these issues regulated more at the local and state levels?

The whole idea gives me a bad taste in my mouth and reminds me of Richard Nixon coming back to San Clemente with his tail between his legs.



DMEQueen

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Re: recording telephone conversations
« Reply #1 on: September 15, 2012, 10:51:02 AM »
It may actually work!  The Federal Law States at least ONE party must know they are being recorded.  If you can find a software that will turn the  phone convo into a transcript you may be better off than you think.  We all know the incorrect benefits quote or pre authorization quotes are a toss up with must persistence and various appeals you may have a better chance of winning with more incrimidating evidence against the insurance company.

These instances can can also help in retraining and training a staff to be more knowledgable than and to challenge  the insurance companies.  Have you thought about doing predetermination for claims you are really weary about?


PMRNC

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Re: recording telephone conversations
« Reply #2 on: September 16, 2012, 01:17:55 PM »
1. That is not the law. The law says BOTH parties must approve .. the carriers record for training quality purposes and that's your chance to hang up  if you want. 
2. It does not matter if you record them misquoting benefits because their disclaimer protects them from errors  "This is just a estimate of benefits, this is NOT a quote as benefits are based on the services rendered at the time of service".   So it's moot and waste of time and IMHO .. unethical.  Also it's not admissible in court unless both parties have agreed.
Linda Walker
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ste

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Re: recording telephone conversations
« Reply #3 on: September 18, 2012, 12:08:12 AM »
I agree with you Linda. I also think its a waste of time but the bottom line here is I want the business.

Michele

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Re: recording telephone conversations
« Reply #4 on: September 18, 2012, 06:37:55 AM »
I'm also thinking that if they are asking for this they may be difficult to work with.  How many years and how many calls did she record to win ONE appeal??  Seems like a lot of work for MAYBE winning ONE appeal.  I agree with you both.  I know I wouldn't agree to it.  There are times that I wish that I had a recording of a conversation but it's more to prove my point and in the end would not be worth the work of recording and keeping track of all calls to get back that one you need. 
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PMRNC

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Re: recording telephone conversations
« Reply #5 on: September 18, 2012, 11:51:40 AM »
It most certainly is not worth it because again, you must obtain the permission of both parties being recorded. The person can tell you they will pay out a million dollars and they will not be held to that based on a recording because of their disclaimer.   An appeal will NEVER be won with a recorded conversation, if it is it's just an administrative decision to do so.  You also have to consider that your claims rep's are like waitresses handling your food. <g>  Not smart to piss them off in this manner when they do NOT have to overturn a denial based on incorrect information given out.   I do have a possible solution that sometimes works, depending on the situation.   For high dollar claims I have my clients request a "pre-determination" where we send in a form with the services to be rendered and the fee, and other fields asking for eligibility date, etc. The carrier in turn will complete the form that YES or NO the fee is within U&C or within the fee schedule allowable, complete the eligibility date or it might even come back that the services are non covered.  We then file that in the patient's file. It's an extra step but can be helpful and more productive than recording phone calls.

Oh and that one biller that recorded and got a claim decision overturned.. she got lucky and embarrassed a claims rep into an administrative decision.. I'm only being honest when I say this, but I worked in claims departments for quite a few years and I would have stuck with the denial so long as the claim was processed correctly. 
Linda Walker
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rdmoore2003

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Re: recording telephone conversations
« Reply #6 on: September 18, 2012, 04:42:37 PM »
I agree with Linda, too.  If you document your call with time, name, etc but also you can get a confirmation number of the call and reference back to that call since it is already recorded.
Regina

DMK

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Re: recording telephone conversations
« Reply #7 on: September 19, 2012, 10:15:07 AM »
And that's the classy thing to do!

Antonysequeira

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Re: recording telephone conversations
« Reply #8 on: September 19, 2012, 11:30:16 AM »
I do agree with Regina... but i have come across with some insurance saying that is not a valid reference number for that insurance...  :)
Antony Sequeira

ste

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Re: recording telephone conversations
« Reply #9 on: October 06, 2012, 11:08:49 PM »
Placing a strain on the working relationship with insurance reps that I've worked hard to cultivate had not entered my mind. Thanks to this string bringing it to my attention and after further consideration I told the prospective client that I would not record phone calls. To my surprise it turned out to not be the deal breaker I had feared and a contract was signed.

Thanks once again for your help.   

PMRNC

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Re: recording telephone conversations
« Reply #10 on: October 07, 2012, 09:03:03 AM »
I spent quite a few years working with insurance carriers and believe me..making them your friend is MUCH more productive. I've cultivated relationships with a rep from each carrier pretty much. Some I can even call when it's not their group/department and they still find time to help me.   I always went the extra mile with an insured or providers office that was courteous and most of all understanding.   Ironically the ONLY time I've found it completely frustrating and can't even bring myself to be nice anymore is with my husband's union plan administrators.. UGH they found a trigger in me that I never knew existed!!
Linda Walker
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www.billerswebsite.com

Michele

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Re: recording telephone conversations
« Reply #11 on: October 09, 2012, 08:21:06 AM »
Our philosophy is the same.  I actually had one who gave me her home number!   8)  Much better to have them on your side, then sometimes when you need help that is a little outside the normal box they are more than willing.  But don't take advantage!  They don't like feeling used or abused.
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midwifebiller

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Re: recording telephone conversations
« Reply #12 on: October 18, 2012, 01:34:19 PM »
I'm suprised to read that denied claims are not paid on appeal when benefits were quoted. We have a form we fill out, complete with rep's name, date and time we spoke to the rep, then a list of questions with space to write in the response. If benefits are quoted, then the claim denied, we send a copy of this form with the appeal letter and the claim gets paid. I won't say always gets paid, but the VAST majority of time the claims are paid.
Kelli Sugihara, CPMB
Midwife Billing & Business, LLC
www.midwifebilling.com

PMRNC

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Re: recording telephone conversations
« Reply #13 on: October 18, 2012, 04:04:23 PM »
Kelly, I agree, there is a chance they could get paid on appeal, I've had some success with doing that as well.. Point is that they do Not have to pay them and having worked as a claims examiner I can tell you the ones you did get paid on were because the examiner "could" or "felt like it" seriously.. that's how it works. Examiners are given administration decision making and it's done on levels. The longer you have been there the higher your payment threshold and the more administrative decisions you can make.  Since carriers do use their disclaimer when you verify benefits it does let them off the hook legally. But I always appealed these anyway, and taking care to do it in a professional way so I don't piss off the claims person :)   
Linda Walker
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midwifebiller

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Re: recording telephone conversations
« Reply #14 on: October 18, 2012, 05:48:07 PM »
We very frequently get denials for one reason or another, that is one of the reasons we will not send a claim without first verifying benefits. We consulted our attorney several years ago, who told us basically that if coverage is quoted, and they have the same plan when services were rendered, then they have to pay. He helped us on some wording with our appeal letters, and we've not had problems since. Since maternity claims deal in the thousands of dollars, it's nice to be able to hold the insurance companies to their word. 

And, yes, I wholeheartedly agree to be professional and nice to the reps!  It has paid off many times throughout the years. I even encourage our billers to send thank you notes--and flowers if the situation warrants.
Kelli Sugihara, CPMB
Midwife Billing & Business, LLC
www.midwifebilling.com