Health is Wealth - Certification Determination

 

I had to call my health insurance company this week.  

It took me two minutes and forty seconds to get through the automated system and get to a live person.  Trust me, when you have an accent, automated switchboards do not like you.

Example:

"Operator"

"I think you said.  Coverage and.  Benefits.  Is that.  Correct?"

"No."

"I'm.  Sorry let's.  Try that again.  Please choose from the.  Following fifty.  Three.  Options billing.  Find a.  Practit--"

"Operator.  Operator!  OPERATOR!"

So, anyway...

I finally get to talk to a real, live human being.

 "Hello this is ____.  How can I help you today?"

"Hi ______.  I need to find out what some treatments will cost me.  I went for a regular check up this week and the Nurse Practitioner advised me to get an MRI and go for genetic counselling.  I want to find out how much those will cost me."

"Do you have the Procedure Codes?"

"The what?"

"The Procedure Codes.  We need to know why these procedures have to be done.  So if you could call and get the Procedure Codes, then call us back and---"

"Hang on.  Isn't there some way that we can do this more efficiently?  Is there any way that the Clinic can give the codes to you through an automated system?"

"Well, they can get a Predetermination of Benefits."

"A what?"

"They can call us and get a Predetermination of Benefits."

"OK..."

"Well, actually, you can get them to do a Precertifiction of Benefits and then wait till they've done that and then wait till we've reviewed and approved it and then call us back and ask for the costs and just tell the operator that you speak to that there's a Precert so that they can look up the Procedure Codes."

"OK so let me see if I get this.  I have to call them, and tell them to contact you to get a Precertification of Benefits.  Then I wait till they do that.  Then I wait till you approve it.  Then I call you and ask for the costs."

"Yes."

"And how long will it take them to get the request to you?"

"I'm sorry, I don't know that."

"And how long will it take you to review and approve?"

"Well, I can't guarantee that it will be approved, but review usually takes 7 to 10 days from receipt."

As always when dealing with the American health"care" system, I was getting really, really pissed off.

It wasn't his fault.  He's a phone operator.  I get that.  But I decided to make myself feel better at his expense, anyway.

"Well, let's hope nothing grows too much in the meantime."

"Yes, Ma'am.  Is there anything else I can help you with today?"

"Well, you could pray for me."

To read more in this series, click here.

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