Callico wrote on Jan 1st, 2010 at 4:05pm:When dealing with ins companies about denial of coverage always go to a supervisor at the very beginning, and then on to a manager if necessary. Those answering the phones are given a very rudimentary training on the different types of policies, and rarely know enough to make an educated guess let alone analysis of your situation. They also are held responsible for anything they approve without proper authority, hence it is easier to say "no" and not dig deeper into YOUR situation unless you read the specific verbiage from your own policy. The fault lies at the feet of the insurance company's lack of training of those representing them much more than on the policies of the companies. The turnover rate of those answering the phones is so high it is virtually impossible to keep the training at a high enough level.
Jerry
Yup....ABSOLUTELY golden advice...I now know how to play the "game". Without a full rehash (see archives) this is what
I've learned. Hope your experiences are better...I'm bitter.....
I work in a service industry. If we treated people like I have been treated...we wouldn't be in business....and I'm not just talking about drones on the phone...
Don't consider yourself a customer...you are not...you are an adversary...act accordingly.
Move up the chain of command at every opportunity...take names and numbers of everyone you talk to...make notes on what is said to you....keep a log.
Put everything in writing...collect every piece of paper. Denials? Fine....dispute them...get a written reply.
Get your doc in your corner. Don't leave interpretation up to the insurance company. In my case, the doc got pissed and wrote a VERY specific letter...with unequivocal statements, demands, and instructions to call if they STILL didn't understand. The insurance company HATES this because it creates a paper trail...one not open to interpretation..one that would bury them in front of a judge.
If your insurance is purchased for your company through a broker...get them on your side too. The broker IS the insurance company customer (you aint)...and they can get stuff done that will put your mind in a spin. If the broker won't respond to you...get the HR dept involved...no HR...get the owner to hammer on them. He who pays the money gets the voice.
NEVER NEVER NEVER give up...that's the strategy...they want you to....dogged determination frustrates their strategy...it can only help when they just want you off ther backs.
SIGH...I don't like being bitter...it's not me...and they did that. I'm not expecting altruism...I don't begrudge profits...but I detect no conscience or soul...it's ALL about money....and in this business...with health and lives at stake...it's GOTTA be more than that.
jon