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Whether you have a claims or a billing question, talking with the people at an insurance company can be a difficult experience. However, the following basic guidelines will likely improve the experience and increase the chances of getting what you want. 

  • Prepare for the call: get your information together and get comfortable.
  • When you call, be prepared to find your way through a phone tree.
  • When you get to the right person, make a friend. In the future, you can return to your friend with additional requests.
  • If you do not get the response you want, ask for a supervisor. Let the person know that the request is not personal.
  • At the end of the call repeat what was agreed to -- including who is to do what.
  • Make notes after the call so you will have all the information you need to follow up if necessary.

For more information about the guidelines, see:

Prepare Before You Make A Call

Set Goals.

Think about the goal or goals of the call. Consider writing the goal(s) down to help keep in mind during the conversation. You may also want to write down specific questions.

Prioritize your questions.

So you can ask the most important first.

Pull together all the information you need for the call.

For instance, your Social Security number, insurance policy numbers, and any bills or explanation-of-benefits forms in question. If you're calling about a question about your coverage, it would help to have a copy of the policy as well -- but don't delay making the call if it will take extended time to find the policy.

Be prepared to take notes comfortably.

Be ready to make notes about the conversation -- on a full size piece of paper or perhaps directly to the computer. Label the page with the date, the time of the call and the number you are calling. If you get transferred from extension to extension, write down each number.

If possible, be seated at a desk or table so you can sit comfortably and be able to write.

Be prepared to stay comfortable and avoid muscle strain -- don't cradle the phone with your shoulder.

A headset or a telephone with a speaker can make delays much easier to bear while you work your way through the maze of a recorded telephone tree, and especially while on hold. If a speaker isn't built into your phone, headsets are not expensive these days. For an example, see Plantronics at offsite link.

Avoid calling from a noisy location.

Background noise can be very distracting to the person on the other end of the line.

Be sure you have enough time for the call.

Most calls take time. In addition to automated telephone menus, you may be placed on hold or have your call transferred from one person to another before you reach the person who is able to help you.

Decide whether to record the call.

Some people suggest recording conversations. If you do, let the other person know you are recording the call. Make a statement to that effect while the recorder is on in case you need proof later on that you disclosed the fact that you recorded the conversation.

If you'd prefer not to let the other person know about the recording, check the laws in your state. In some states it is illegal to record conversations without informing the other party.

Work On Your Mind Set.

The most annoying aspect about working with insurance companies today can be the phone tree (which is discussed below) and being kept on hold endlessly, disconnected or transferred to someone who can't help you. Rather than tense-up at the thought this may happen during the call, prepare for it.

If you're in a car at a traffic light and in a hurry, you get tense and possibly angry waiting for the light to change. If you're not in a rush, you don't even notice the time passing. Go for the latter feeling when making a call.

Have Something To Do While You're On Hold.

Be sure it's not an activity that distracts you from hearing any phone tree prompts or the person who finally says hello but may hang up if you don't respond immediately. If you're caught off guard, at least say something like "Please hold on" to let the person know you're at the end of the line and they shouldn't go on to the next caller.

Add your own ideas to the following suggestions for things to do while on hold:

  • Skim a magazine.
  • Play solitaire on your computer or with a deck of cards.
  • Do a puzzle such as a crossword puzzle or Sudoku -- preferably something that doesn't frustrate you.
  • Prepare the grocery shopping list.
  • Leaf through that stack of mail order catalogues that has been piling up.

What To Do When You Are Ready To Place The Call

Think about how to get through the computerized telephone tree

This is the first and sometimes the largest hurdle to overcome when calling an insurance company. As you work your way through the system's layers, write down which numbers you push and where you go. This will help speed up your future calls.

Patience and calm are difficult to maintain -- particularly if you end up at a place you've already been before. However, it's necessary to be patient and remain calm so you don't end up yelling at the first person who answers, assuming you do get a human.

Check out offsite link to see if it lists the key to getting through to the company you're calling.

If the company isn't listed, suggestions that may help you get to a human quicker are:

  • Don't push any numbers once you connect with the central number. Often the computer will assume you have a rotary phone and will switch you to a live operator.
  • If that doesn't work, Push 0. If pushing zero once doesn't work, try pressing it two, three or even four times while ignoring prompts that say something like "invalid number." Sometimes *0 or 0# also works. If you're lucky you'll be connected to an operator.
  • If the system is voice activated, instead of pressing "0," speak the word "operator" or "representative" or "agent."
  • Today's systems that route calls also have the ability to assign low priority to frequent callers or high priority to someone who's calling back after abandoning the system on previous attempts. You can try calling and hanging up several times to see if that works.

Do not expect the first person you get to be the person you need.

The first person you speak with is probably not the person you need to speak to so don't start into your whole story. Instead, ask to speak to either the person by name or to the department you need. Explain your need concisely. For example:

    • "I need to speak to someone in group health claims"
    • "I have a billing question about my individual health insurance policy. Can you connect me to that department?"

Collect names

Once you're past the operator, find out with whom you're talking. Rather than start out with a cold, "Who are you?" offer first, "Hi, my name is Lorenzo Jones, what's your name please?" When you obtain the name, write it down. In addition to writing it down correctly, also write it in a style that will make it easy for you to remember how to pronounce it later. For example, the name, Sheenan could be pronounced "shhh-neen".

Some companies won't allow employees to state their full name Generally a first name with the phone number and department is sufficient to identify the person later if necessary.

Get the name right

Sometimes, people answer with, "Claims, Shrrrtcpplxt Ann speaking." Don't wait or guess. Now is the time to get it right: "I'm sorry I didn't catch the name. How do you spell it please?"

Use the name back

Let the person at the company know you need his or her name so you can talk more easily. For example: "Well, hi, Carla Ann, my name's Belle Jones. I have a question about my bill. I sure hope you can help me." If the person offers that she goes by a nickname, note the name -- and use it.

When you get the right person in the right department

  • If your frustration is overwhelming by the time you speak with the person who can help you, rather than screaming at the person, let him or her know as calmly as you can that you need a moment to get past the frustration because of the difficulty you had getting through to the person.
  • Ask for a direct phone number "in case we get cut off." You don't need to also state it, but having the number will also make it easier for you in the future.
  • It's time to make a friend.

How To Make A Friend At The Insurance Company

Making a friend with the person with whom you will be working in the insurance company is very important. Insurance companies are made up of people, and people can exercise discretion as to how things go. The more of an individual you can become to the person in the insurance company, the more likely you will get what you need, or at least fair treatment.

Get and use the person's name

Often when people at large companies are asked their name, they react negatively. To reduce the chances of a problem, consider saying something like:

"My name is Cathy Merritt. Would you mind telling me your name please?"

If you don't understand the name, or how to pronounce it, ask the person to spell it for you or to pronounce it again. If the name if the least bit unusual, it couldn't hurt to let the person know if you find the name interesting.

Speak in a friendly manner

The person you work with at the insurance company is a friend, not your enemy…..yet. Be friendly and expect friendliness back. You'll usually get it.

Being friendly doesn't mean you shouldn't be assertive. In fact, be as assertive as necessary to get what you want. After all, you are the customer.

Engage the person. Open yourself.

  • If you open yourself, the odds are she or he will do the same. For example, tell the person what condition you have. Let him or her know facts that probably apply to them as well such as "I'm a mother, or a dad…"
  • Empathize with the person at the first opportunity: such as, "Gee, I bet you have a hard job." or "You must be VERY busy. Thank you for being so patient with me."

Ask for help

It usually works to ask for help to get what you need, and in the shortest amount of time possible. A good approach could be to tell the person you are a novice at this, (you've never done this before), you don't understand insurance at all (they assume you don't, but it's refreshing to them to hear someone admit it), and you know the person with whom you are speaking is an expert. "Can you help me?" or "I need your help. I really don't understand what's going on. You're an expert. Can you explain it to me?"

Sympathize with the pressure the person is under.

Most employees are under pressure to get more done in less time. Work loads can be unbearable. Company rules can be difficult. It helps if you let the person know you understand the pressure and appreciate the time and consideration they are showing you.

Use anger sparingly

  • Don't be obnoxious or treat the person as an adversary.
  • There are times when controlled anger works, but use anger sparingly. Once anger is out of the bag, you can't take it back.
  • If, in reviewing your problem, you feel yourself getting upset all over again, make sure the person knows your anger isn't directed at her personally. "Please don't think I'm angry at you personally, Carla. I know you're trying to help me. It just gets me so frustrated sometimes."

Stay with your friend

  • Let the person know that whenever you have questions, you will call him or her. The odds are the person will be more responsible in her dealings with you.
  • Get the person's direct phone number or extension.
  • When you do make the repeat call, ask for your friend. If she's not available, find out when she will be and call back, even if it's not until the next day.
  • You won't always make a friend. Some companies time their employees' phone calls to push them to handle more, and some claims people just aren't that nice. You have to decide when making repeat calls whether it's worth asking for this person who already knows about your situation, or starting again with a stranger.

By following this procedure and making a friend, a claims person with whom she had become friendly recommended a procedure to Mary C that her doctor had not even mentioned. The procedure saved Mary's life.

How To Ask Your Question

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.

If You Do Not Get The Response You Want: Ask For A Supervisor

If you don't reach the goal of your call, whether it's because you don't agree with what the person on the phone tells you or they're just rude or incompetent, stay in control of the situation and ask for a supervisor.

  • If the reason you're asking for the supervisor is not the person's behavior, let the person know you don't intend to complain about them, but that you either need more information or to speak with someone in authority.
  • If the reason for asking for the supervisor is the person's behavior, or lack of it, you don't need to call the person on it -- just ask for the supervisor.

If the person refuses to connect you to a supervisor, repeat their name (or ask for it if you don't have it) and try a reasonable approach such as: "Judy, I understand you're doing your job, but I'm just not happy and I really need to speak with somebody in authority. " Let them know you're serious -- and insistent.

If you're told there is no supervisor on duty, be skeptical. Most companies do not let their telephone operators work without a supervisor present.

If politeness doesn't work, try to avoid anger, which at this point can be self -defeating. Instead, consider asking, incredulously, "Let me repeat this Judy. Are you telling me you will not connect me with a supervisor?"

If the answer is still that you won't be connected to a supervisor, we've often found that you get to speak to a supervisor if you ask for the name and phone number of the president of the company. Even if the request for the president's name doesn't get you to the supervisor, if you hang up and call the president and complain. You'll probably get to speak with the president's assistant who will make sure your request is sent to the right supervisory person with a note of importance because the request to take care of your problem comes from the top of the organization.

If all else fails, hang up and call again. Hopefully the next person that answers your call will be more friendly to your cause.

How To Talk With A Supervisor

Talking with a supervisor is no different than speaking to the customer service or claims representative. The difference,hopefully, is that a supervisor will know more about the issue and how to interpret rules or policy provisions in your favor, or how to get around unfair rules.

If the supervisor cannot help, perhaps he or she has a supervisor that you can speak with.

Once you speak with the supervisor, ask whether you can ask for her again in the future. If so, is there a direct line? If not, with whom would he or she suggest you speak?

If the supervisor doesn't give you the answer you're seeking, see How To Appeal An Insurance Company Denial.

What To Do When It Is Time To End The Call With The Insurer

You learned all you can from the person with whom you've been speaking. Don't just hang up -- you're not finished yet.

Summarize the result

Make sure you both understand the result -- she is sending you something or you are sending her something or you're writing an appeal to someone else, etc. It's the best way to assure you are both on the same page.

Get the person's direct phone number

If you don't already have it, now is the time to ask if there's a more direct way to reach her if you need to call again. Is there a direct number or an extension? Direct lines are generally not toll-free but will save you time.

Thank the person

Thank the person for his time and for being such a great help (if appropriate) and use his name again. "I'm sorry you're denying my claim. I obviously disagree and will be sending in an appeal. But, Barry, I want to thank you for taking the time that you did to explain it so thoroughly to me."

What To Do After A Call With An Insurer

After completing a call with an insurance company, it  is advisable to:
  • Finish your notes about the call. Make the notes clear enough that even on a bad day, you'll understand what they're about. It's better to write too much than too little.
  • Add the name and phone number to your contacts at the company.
  • Store the notes with your file on the particular subject.
  • Take a deep breath. Relax. Congratulate yourself on a job well done.

Next time you have a question about the subject, try to work with the same person, particularly if it is about a claim.

  • Wait for the person if necessary. For example, if the person is out of the office when you call in the morning, leave a message that you'll call again in the afternoon.
  • You will frequently encounter someone who insists, "any representative can help you." If that happens, let them know that the person you're asking for is already up to date on the situation and you would prefer to speak with them.