Starting a Medical Billing Business > Starting Your Own Medical Billing Business
recording telephone conversations
PMRNC:
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!!
Michele:
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.
midwifebiller:
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.
PMRNC:
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 :)
midwifebiller:
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.
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