July 30th, 2010 by David E. Williams of the Health business blog
Often when a dependent or I have a claim we get a letter asking us to call Healthcare Recoveries who works on behalf of our insurer, Blue Cross Blue Shield of MA. I know what they want: they are trying to figure out if someone else is at fault for an injury, whether the claim should be for workers comp instead of medical and whether I have other insurance beyond Blue Cross that might pay some or all. I usually try to ignore these requests because I know the claims are legitimate as billed and I don’t want to deal with the hassle.
But today, after getting a second request letter with a lot of bold print I decided to go ahead and make the call, which I’ve recorded in its entirety for your listening pleasure.
I’m not sure how much Blue Cross pays for this service but my guess is they’re getting their money’s worth. The total length of my call was 3:40, which included 1:05 of an automated system telling me why they’re calling and getting my event number. Then there’s 30 seconds of hold time, which is quite acceptable. Then about 2 minutes of interaction with a live operator, Tim.
In this case Tim was professional and courteous. He took it in stride when I told him I was recording the call, and he moved through the questions efficiently. As you’ll hear, this claim appears to include a mis-coding, which is something Tim must encounter all the time. He handles that one pretty well, too.
After determining that we can’t easily blame someone else for this injury, Tim double checks to see if this could be work-related (not likely considering the demographics of the patient) and whether I have any other insurance. After that we’re done!
In the recording I redacted identifying information about the patient and me so you will hear a few gaps.
I’m slightly annoyed that this business exists, since it basically just redistributes costs around the system. But as a Blue Cross Blue Shield customer I guess I’m pleased overall because it is probably keeping my insurer’s medical costs down, which might limit my premium increases at some point if I’m lucky! The interaction is perfectly pleasant and there is no sense that the insurer is trying to put the squeeze on me.