We are billing specialist, we manage medical claims, what goes out what comes back, what got denied, finding out why, etc and you have to dig deep sometimes to get to the finish line! One of the biggest challenges is working with an insurance rep who is reading from a prompt and are essentially clueless, or one department doesn’t know what the other department is doing and you can never get to that person who can fix the issue. Case in point that I’m working on right now is with Humana Military, specifically Tricare East. Months we have tried to resolve a very big issue with corrected claims. Their process is very complicated to manage and there is no way to get to a person in the recovery department. So you speak to CSR’s who are equally frustrated, they are doing the best they can but with limited resources and when it comes to corrected claims or their recoupment process, frankly they are at the mercy of this elusive recovery department and it is a nightmare. I’m saying this not to slam Humana Military or its staff, I’m just laying out on the table that if you do not have personnel who can manage the day to day grind with insurances you will lose money, there is no doubt in my mind. You have to be able to stand your ground, stay with it to resolution, track activity, try to find that provider rep who can facilitate if necessary (as is the case with Tri East) until you get to resolution. In truth, if you do not manage this process your money will go down the drain. Billions of dollars do not get paid yearly to providers in the United States because their staff does not have the time or the know how to fight these battles and ultimately insurances will close claims if they are not resolved. It is in your best interest to know how your office is handling communication with the various different insurances, what are you losing down the drain and is it worth giving that some attention, it could make a big difference in your practice.
