How to run an insurance call so that you never have to make it twice

Before you dial: six things on the desk

Never make this call from the car. You will need to write, and you will be asked for numbers you cannot recite.

Have these in front of you before you dial. The call takes half as long and you avoid the ending where you have to ring back tomorrow with a document you did not have.

One of these deserves a separate mention. Most plans will not discuss your parent's account with you unless a form is on file authorising it. Ask, in these words: "What do you need on file before you can discuss this account with me, what is that form called, who sends it, and how long does it take to be processed once it is returned?" Write the name of the form down. Chase it in a fortnight if you have not had confirmation. Everything else on this page depends on that form existing.

• The member ID card, or a photograph of both sides
• Your parent's full name exactly as it appears on the plan, and date of birth
• The claim number, authorisation number or reference number if there is one
• The date of service and the name of the provider — the exact date, from the log
• The letter you are ringing about, in front of you, with the reference at the top
• A pen, a printed call log sheet, and forty minutes you are not going to be interrupted in

The call log that ends the arguments

One sheet, one row per call. This is the single highest-value piece of paper in the whole folder, because insurance disputes are almost always resolved by whoever can say what was said, by whom, on what date.

Three habits make it work. Ask for the agent's name and ID at the start, before the conversation begins, not at the end when they are trying to leave. Ask for a reference number for the call itself before you hang up — most systems generate one and most agents will not offer it. And write the answer in their words, not your understanding of it, in quotation marks.

Close every call the same way: "Can you send me that in writing, to the address on file, and can you tell me the reference number for this call?" Then read the reference number back.

• Date and time of the call
• The number you dialled, and which department you ended up in
• Agent name and agent ID
• Reference number for the call
• What you asked, in one line
• What they said, in their words, in quotation marks
• What they promised to do, and by what date
• What you have to do next, and by when
• Date you chased it

The coverage questions, asked so the answer is usable

Vague questions get vague answers. "Is this covered?" produces "it depends." Ask so that the answer can be written down and used.

Name the item, the date, the provider, and the code if you have it. Then ask them to tell you where the answer lives. "Which page of the plan document says that?" is a fair, normal question, and it converts an opinion into a citation.

Always ask for it in writing. A verbal yes from an agent who leaves the company next month is worth nothing.

• "Is this item or service covered under this plan, and at what level?"
• "Which section of the plan documents covers that? Can you send me the page?"
• "Does this require prior authorisation before it happens, and who submits it?"
• "Has an authorisation already been issued? What is the number and what dates does it cover?"
• "How many visits or units are authorised, and how many have been used?"
• "What code was this claim submitted under?"
• "What is the deadline for anything I have to submit, and does the postmark or the receipt date count?"
• "Can you send me that in writing, and to which address on file?"
• "Is there anything else on this account that needs my attention today?"

When something is denied

A denial is a document, not a verdict, and there is a defined process behind it. Your job is to find out what that process is and to meet its deadlines. It is administration, not argument.

Get the denial in writing if you only had it by phone. Ask for the specific reason code and what that code means in plain words. Ask for the exact appeal deadline as a date, not a number of days, and ask what date the clock started from.

Ask who submits an appeal — you, the doctor's office, or the facility's billing department. Very often the provider's billing office does this routinely and is better at it than you will be. Ask them directly: "Do you handle appeals on this, and have you already submitted one?"

Ask where the appeal goes: an address, a portal, or a fax, and what form is required. Ask what happens after it is submitted, how long a decision takes, and how you will be told.

Keep the envelope with the postmark. Keep a copy of everything you send, and send anything with a deadline by a method that produces a receipt. Write the deadline date in your calendar with an alarm five days before.

The paper trail, filed so a stranger could follow it

Assume that at some point someone else will have to pick this up — a sibling, or you in eighteen months with no memory of it. File accordingly.

One folder per claim or per issue, not one folder for insurance. Write the claim number in the top-right corner of every page as it comes in, by hand, in the same place every time.

Keep every explanation of benefits, even the ones that say you owe nothing. They are the dated record of what was billed and what was allowed, and they are what you will need when a bill arrives eleven months later.

File in date order with the newest at the front, and keep the call log at the very front of the folder so it is the first thing anyone sees.

Scan or photograph anything with a deadline on it the day it arrives, and put the deadline in the calendar immediately — before you file the paper, because filing is where things get forgotten.

And note on the call log which sibling has been sent a copy of what. It removes an entire category of family friction at the cost of one column.

Who else can make the call

You do not have to be the one on hold. Several other people have a professional reason to make the same call, and some of them have a direct line you do not.

Ask the plan whether a case manager is assigned, and if so, get the direct number and the name. That single question sometimes replaces the entire hold queue for everything that follows.

Ask the doctor's or facility's billing office to speak to the plan directly about a coding or claim question. It is their normal work, they speak the same language, and they can often resolve in one call what takes you four.

Ask the equipment supplier who handles authorisation on their side, and get that person's name.

Give a capable sibling a defined piece of this: one issue, one folder, one phone number, and the rule that everything goes in the shared call log. "Deal with the insurance" is not delegable. "Ring this number about claim 4471 and write the answer on the log" is.

And when you have finally got a clear written answer about something, keep it. The same question will be asked again next year, by someone else in the family, and you will be able to hand them the page.

Questions