Health Care Suckage

[tropicsgoddess]

BG: I currently work in the customer service/call center department for a NY based health insurance company. Most of the calls we get are the members, but here and there we get calls from doctor's offices,clinics,hospitals and the like about the status of claims.


It Never Ends......

My co-worker T___, who sits next to me had a call that was about an hour or more because a hospital called to check the status of 20 claims (and she got that call the minute she came back from lunch).


Access Denied....

Legally we can't discuss a member's insurance info and the like with anyone other than the member or a health care provider unless the member gives us permission over the phone or if we have legal documentation on our system that specifies who the member allows us to disclose their info to (brother, sister, etc.).


I had a woman who called to inquire about if her sister had any coverage in her plan for nursing home , because of the extent of her sister's injuries from an accident. I looked up and saw that there were no legal doc's on file stating that I was allowed to discuss the member's info with her and the member wasn't there to give me permission to discuss her info with the woman on the line. She was livid. I had to keep telling her that and recited the HIPAA laws to her until I was blue in the face, but she wasn't having it and demanded a supervisor. Before I could even get a supervisor on the line,she hung up.

[BookstoreEscapee]

My co-worker T___, who sits next to me had a call that was about an hour or more because a hospital called to check the status of 20 claims (and she got that call the minute she came back from lunch).

She should just be glad she didn't get it the minute before she went to lunch!

[Peppergirl]

She should just be glad she didn't get it the minute before she went to lunch!

Or at the end of her shift.

I got one last weekend at 955pm (I leave at 10p) who said "Yes, I have a number of things to book."

*sigh*

It had been one of those days and the thought of staying even ONE minute past my 12 hour shift made me want to gag, so I called the 3rd shift guy and begged him to take the call. He's a sweet southern boy, so he did it.

I call to thank him the next day and he had gotten dinged for a mistake on one of the ones he booked for the guy.

Figures! I felt sooo bad.

"No good deed goes unpunished, sweetie" he said, in his southern drawl.

I owe him BIG TIME for that.

Sorry for the threadjack!

[smileyeagle1021]

She should just be glad she didn't get it the minute before she went to lunch!

you beat me to it... though I've had that happen before when it's only like 3 minutes before my break, I'm reaching for my aftercall button to remove myself from the call rotation and I hear *beep* and then it's like f*ck
especially when I ask how I can help them and they say that they need 9 rooms friday night through monday morning... oh and they need that repeated for 8 weeks... and I have to book it if it's available (it's not until 10 rooms I can pawn it off on a manager)... that is 72 separate reservations that I have to do

[theredbaron47]

Ever notice how HIPAA, while intended to protect the privacy of the public, usually succeeds in accomplishing nothing except being a pain in the ass of health care providers?

Hell, most of the pharmacy customers don't even know what HIPAA is, and they'll scream across the pharmacy, "Hey, I need my Valtrex (herpes medication) refilled, do I do that here or there??"

[marasbaras]

Ever notice how HIPAA, while intended to protect the privacy of the public, usually succeeds in accomplishing nothing except being a pain in the ass of health care providers?

Let's not forget that it's an equal pain for family members just trying to sort things out when someone is injured or sick.

[Gerrinson]

Ever notice how HIPAA, while intended to protect the privacy of the public, usually succeeds in accomplishing nothing except being a pain in the ass of health care providers?

Let's not forget that it's an equal pain for family members just trying to sort things out when someone is injured or sick.

This is why I would suggest to everyone that you set up a living will. Provide a copy of it to the insurance company and the person designated in the will can speak to them and make decisions for you. In a worst case scenario, they can have the machines unplugged and let you die quickly (which is part of the reason I'm setting up a living will.)

You do have to be careful to whom you give authority, of course. I've chosen my best friend rather than my parents because he and I have discussed the situation and he knows, and agrees with, my wishes. My parents vehemently disagree with my "unplug me if the machines are the only keeping me alive" stance. It's fine if I'm in ICU recovering from a major injury, but day in, day out for years? Forget it, just unplug me and let me die.

Erm, anyway, threadjack over.

[tropicsgoddess]

This is why I would suggest to everyone that you set up a living will. Provide a copy of it to the insurance company and the person designated in the will can speak to them and make decisions for you.

You do have to be careful to whom you give authority, of course.

If a member wanted the legal docs to designate who they want us to disclose their info to, we can send them what's called a HIPAA Authorization. All they do is just fill it out, send it back to us and we file it in the computer. They send in their power of attorney docs too. The living will is definitely a good idea. I would rather give my fiancé power of attorney than anybody else if (god forbid) anything happened to me.