Constant battle

Medical insurance issues and authorizations are my thing. It's what I do. It's been at least part of my job for more than 10 years now. I get journals and magazines and do seminars and continuing education in the field.

Even with, and maybe due to, this expertise, I get SO frustrated at how wrong some of the practices we deal with in Braska's care can get what should be a simple process. How in the world do parents do it that don't know how the system works?!? When they get an EOB (the explanation of benefits from the insurance that tells you what they pay and what they won't for a particular visit or service), and it says something is denied, do they just pay it and suffer the economic setback or do they know that there are any of 15 things that could be wrong causing that denial to be incorrect?

I've spent the morning calling our case manager at the insurance--who is little help, unlike the previous ones we've had--getting no pertinent info other than what I was telling HER. I had to tell HER how it should work and what her next step should be. Then I called the therapy location to inform THEM how to bill properly so that they will get paid. Now, mind you, I've done this at LEAST 2 times before for both these entities. I always try to be very nice when I deal with people on the phone that I know I'll be encountering again, so as not to start a bad rapport with them. But this time it was business to the point. Here's why it's denied. Here's what you did wrong. Here's how to fix it. Here's who to contact. Here's what to do next. And then I require them to call me when it's done correctly so I can follow up and make sure.

Sure, I've been a boss in this position for years, and it's not hard for me to take the demanding position, but when it's been in and out their ears with no good result, it's time to make things clear. I can recite diagnosis codes by the hundreds and I can pretty much tell you what things will be covered and what won't for several major insurances. I'm thankful I have this background in our situation, but so many of you don't! How in the world do you do it?!? I'd lose my mind... I'm close already!

Ok, I don't really vent often, but I'm just so tired of doing the work of all these other people who I'm paying to do their job! I'm very thankful for insurance, and I know the system CAN work when people will just pay attention and learn what they need to know. I can't train everyone myself! :o)