1.29.16 Issue #725 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Belle DuCharme, CDPMA
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On-Hold Times Affecting Your Profits?
By Belle DuCharme, CDPMA

“All of our representatives are currently assisting other callers. Please remain on the line and the next available representative will assist you.”  

A familiar recording when calling insurance companies is sometimes all you will hear, unless you have the time to wait on hold. Waiting on hold can seem like forever and all you can think of is what you can’t get done as the frustration mounts.

Being placed on hold is just part of the day for those working claims in dental offices. The average wait time used to be ten to fifteen minutes, but my latest reports show that wait times have increased to two to four hours in some situations. This issue has not just affected healthcare providers; it also has affected patients who need to know their policy coverage prior to surgery or other treatment.

Is it safe to say that insurance companies don’t care about customer service? No. They do care, they just aren’t prepared for the backlash of the Affordable Care Act. With thousands more people covered than were prior to the Act, a huge surge of calls to the call centers has caused the customer service ratings of many insurers to plummet.

In a dental office, the Business Coordinator has an average 8-hour day to complete all tasks, with priority on the needs of patients and staff. When you have to place the insurance company on hold to answer the other line, they will not wait for you when they finally answer. Hiring another person to work claims is what most offices do because there just isn’t enough time in the day. The more network insurance that is accepted, the more time spent verifying eligibility and benefits. What you save by accepting more insurance is often eaten up by the costs to hire and train more people.

If you don’t check eligibility and verify coverage and benefits, you risk claim denials and very unhappy patients who now have to pay out-of-pocket for something they thought was covered. What can we do? Here are some suggestions:

From your software, get a list of all in-network insurance companies and then the top 5 out-of-network providers. Make sure you have created a login and password to each of their online portals to get patient benefits. It is always harder to get the information when you are out-of-network, but it can be done. Type up the list and put it in a plastic cover at the desk of each person who calls for benefits.

Call first thing in the morning to avoid peak call times. If they are available on Saturday, call then.

Try to bypass messaging by hitting the 0 (zero) or * (star) key to reach a live operator.  This may or may not work.

Search the insurer’s website to see if questions are answered there, although individual issues like benefits left for the calendar year won’t be there.

If you can’t get through, search for contact information of someone higher up in the organization who might help put you ahead of the line.

Complain about excessive waits to your state insurance department or insurance commissioner.

Contact the patient and let them know you have tried for hours to speak to an agent and see if they can get through quicker from their end. Give them the list of questions for the insurance company.

As of now, 2016, Aetna insurance company will no longer give complete breakdowns on a phone call. They want you to request a fax first, and if that doesn’t answer your questions then you can call back. Some insurance companies are having you email your questions and then they will respond. This is not as quick as a phone call, but that is why you must verify coverage prior to the patient coming in rather than when they are there for an appointment.

Insurance companies are trying to help this situation by extending their call hours of operation and making email available. This is also being pushed by social media because claims processors and patients alike are very upset over this situation. For now we all need to stay positive and seek to remedy the situation within our offices. Hire help or create more time for your business staff to call insurance companies until the situation is under control.

For more help with training your business staff, call McKenzie Management today and sign up for customized business training.

If you would like more information on McKenzie Management’sTraining Programs  to improve the performance of your team, email training@mckenziemgmt.com

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