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How To Talk With The People At Your Insurance Company (Make A Friend)

How To Ask Your Question

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What is needed to find your file?

Once you're past the "make a friend" part of your call, the next step is to see what the person with whom you speak needs to find your file. "What do you need to look me up, my Social Security Number?" Let the person get up to speed before you launch into your issue.

State your goal

Once she has your file, let her know the goal you're seeking, then give a brief summary of the necessary information. "I want to know the status of a claim. My doctor's still billing me and I want to make sure you process it before I pay my portion. It's the bill from October 6."

Understand the explanation

  • Listen to the explanation without interrupting. Focus on taking notes of what she says. Once you have the information, repeat it back to make sure you've got it right and to give yourself time to finish writing the response: "Let me see if I have this right. You consider this lab test to not be medically necessary so you won't be covering it. Is that it?"
  • Ask your follow-up in a friendly manner; for example, "Please explain this to me. I don't understand. You covered this same test two months ago. Why was it medically necessary then but not now?"
  • If you don't understand, keep asking, preferably from the role of the bewildered layperson asking an expert. It doesn't matter at this point if you agree with what you're being told: the key is to be sure to understand what is being stated. Swallow your pride. Go with the attitude that her explanation is not the problem. Rather, it's your layperson brain that just doesn't understand insurance or the situation.

Agree on what happens next

  • If you agree with the company's position, before hanging up, make sure you both know what happens next -- they send something to you, you need to send something to them, or nothing needs to be done by anyone.
  • If you don't agree:
  • Ask: What is the next step? If you received a denial, the next step is getting the denial in writing. See Appealing a Claim.
  • If you have to provide missing information, get the name and address of the person (and preferably the direct phone number) to whom you should send the information, as well as the date by which they should receive it.
  • If the company is to send something to you, ask when it will be sent out.

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