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A little background: I work for a large health insurance carrier. I've been here for more than six years. There's been many changes over the years, some corporate, some HIPAA related, some that helped make things easier and some that are of course absolutely stupid - at least on the surface.
About four years ago we launched an internet portal that gives the professional and facility community contracted with us access to routine member benefits, claim status, automated authorizations requests and resource materials. They can submit their claims thru it and monitor it every step of the way. They can even send their requests for claim adjustment thru the internet and they can our notes on the case and see the adjustment as soon as it is done in real time. Self service at its most effective.
There used to be more than 120 people in my department, now there's less than 30. Don't tell me that it isn't more cost effective for the practice as well as us - you don't have staff waiting in queue to talk to us for things that are now three clicks away.
Another important this about this is we pay for the practice to have the portal access not the practice. Because of that a practice that is enabled and trained is required to use the internet portal.
We are only allowed to assist with complicated issues and information that is not available thru the internet portal. With the one exception being if we are notified by the company that administers the site for us that there is a technical problem and the site is taken offline. Otherwise Customer service is not allowed to assist with routine informaiton. We have an automated telephone and fax system they can access if their practice is having computer problem or for some reason they just don't want to use the internet.
There are still people that try to get around it. They'll pretend they aren't contracted. They'll give their tax id instead of provider id. They'll yell and cuss and demand a supervisor when we catch them at it and tell them that they have to use the internet.
I can understand where they are coming from up to a point. Yes, I have the information right in front of me and I'm still not allowed to give it over the phone. The fact that you forgot your password or don't remember where to look for mental health benefits does not change the contractual obligation that you have to use the service we are paying for you to have the access to use.
No, it does not matter that the girl that knows how to use it is on vacation. I can send a request that someone go out to train you, in the mean time use the automated system.
No, they aren't going to remove the access from your file and let you keep the access.
Yes, I know it sucks. I'm still not willing to break the rules for you, even if I can see why you think it's stupid, especially when you've been nasty to me.
If they'll let me, I am happy to help them navigate the internet portal site to locate everything they need... as well as some useful things that they don't even know exists. I live for that. It's the only part of my job I enjoy anymore.
I just got off of a call that was typical of the suckier internet enabled caller. "Joyce" pretended not to know her provider id, but insisted she's contracted with us as an in network provider. Eventually she gave a National Provider Id. I guess she didn't realize that the NPI is linked to the provider file that shows the internet access that the practice has had since 2003.
They usually get suckier when they get caught and Joyce was no exception to that. I told her that she has the access to the routine benefits and enrollment on the internet. She cut me off when I reminded her that it has been several years since that initiative was put in place.
She just kept getting suckier. She threatened to not render services [that's on your conscious, not mine], said they wouldn't see our members anymore [that's on your finances, not mine], said they'd make the member's pay up front and submit their own claims [that's violating your contract with us]. Said she'd just have the member call member services [that's just fine, maybe member services can help them find an in network provider that doesn't have sucky staff].
She wanted my first and last name. Um. No. You can have the first initial of my last name and you can go right ahead and complain that I followed the rules. I desperately wanted to say, do you want me to dial you in so you can tell them how I followed the rules? How about we pull the tape from this phone call? Shall I have a copy of the tape sent to your boss as well?
Don't treat me like I'm stupid.
Don't try to pull a fast one.
Don't try to convince me to break rules for you, especially after mistreating me.
Oh, and don't be surprised when I pull the last several years of your claims to audit for possible overpayments.
About four years ago we launched an internet portal that gives the professional and facility community contracted with us access to routine member benefits, claim status, automated authorizations requests and resource materials. They can submit their claims thru it and monitor it every step of the way. They can even send their requests for claim adjustment thru the internet and they can our notes on the case and see the adjustment as soon as it is done in real time. Self service at its most effective.
There used to be more than 120 people in my department, now there's less than 30. Don't tell me that it isn't more cost effective for the practice as well as us - you don't have staff waiting in queue to talk to us for things that are now three clicks away.
Another important this about this is we pay for the practice to have the portal access not the practice. Because of that a practice that is enabled and trained is required to use the internet portal.
We are only allowed to assist with complicated issues and information that is not available thru the internet portal. With the one exception being if we are notified by the company that administers the site for us that there is a technical problem and the site is taken offline. Otherwise Customer service is not allowed to assist with routine informaiton. We have an automated telephone and fax system they can access if their practice is having computer problem or for some reason they just don't want to use the internet.
There are still people that try to get around it. They'll pretend they aren't contracted. They'll give their tax id instead of provider id. They'll yell and cuss and demand a supervisor when we catch them at it and tell them that they have to use the internet.
I can understand where they are coming from up to a point. Yes, I have the information right in front of me and I'm still not allowed to give it over the phone. The fact that you forgot your password or don't remember where to look for mental health benefits does not change the contractual obligation that you have to use the service we are paying for you to have the access to use.
No, it does not matter that the girl that knows how to use it is on vacation. I can send a request that someone go out to train you, in the mean time use the automated system.
No, they aren't going to remove the access from your file and let you keep the access.
Yes, I know it sucks. I'm still not willing to break the rules for you, even if I can see why you think it's stupid, especially when you've been nasty to me.
If they'll let me, I am happy to help them navigate the internet portal site to locate everything they need... as well as some useful things that they don't even know exists. I live for that. It's the only part of my job I enjoy anymore.
I just got off of a call that was typical of the suckier internet enabled caller. "Joyce" pretended not to know her provider id, but insisted she's contracted with us as an in network provider. Eventually she gave a National Provider Id. I guess she didn't realize that the NPI is linked to the provider file that shows the internet access that the practice has had since 2003.
They usually get suckier when they get caught and Joyce was no exception to that. I told her that she has the access to the routine benefits and enrollment on the internet. She cut me off when I reminded her that it has been several years since that initiative was put in place.
She just kept getting suckier. She threatened to not render services [that's on your conscious, not mine], said they wouldn't see our members anymore [that's on your finances, not mine], said they'd make the member's pay up front and submit their own claims [that's violating your contract with us]. Said she'd just have the member call member services [that's just fine, maybe member services can help them find an in network provider that doesn't have sucky staff].
She wanted my first and last name. Um. No. You can have the first initial of my last name and you can go right ahead and complain that I followed the rules. I desperately wanted to say, do you want me to dial you in so you can tell them how I followed the rules? How about we pull the tape from this phone call? Shall I have a copy of the tape sent to your boss as well?
Don't treat me like I'm stupid.
Don't try to pull a fast one.
Don't try to convince me to break rules for you, especially after mistreating me.
Oh, and don't be surprised when I pull the last several years of your claims to audit for possible overpayments.
Where was I, anyway? Thanks for filling in for me, DF!!!!! 
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