Understanding Health Insurance and You: Part Three

21 de January de 2021

(English) Communication can be challenging. For starters, words are open to interpretation. Not to mention our emotions can often get the best of us, especially in high-stakes conversations. While these things are true, it’s also true that better communication is possible. That applies to both personal and professional relationships. Especially when those relationships involve your healthcare.

(English) Before you reach out to your insurance company, you’ll want to understand how insurance works and to see your insurer as a partner in your health. Once you have a good handle on both of those topics, you’ll be ready to reach out when you have a question or a concern. Here’s what to do before and during your insurer conversations.

What to do before contacting your carrier

  1. Review your Summary of Benefits. This may have the answer to your question or concern. You might also find more information to solve your question on your own.
  2. Get your member ID card and any relevant materials such as a bill or a claim ready and have them on hand.
  3. Have a short, clear statement for the call prepared. For example, if you’re calling to see if an upcoming procedure will be covered, get the diagnostic and procedural codes from your doctor in advance.
  4. Try contacting your licensed health insurance sales agent for help first. Your agent can either assist you on the spot or reach out to your insurer on your behalf.
  5. If you’re not sure who your insurance agent is or if you don’t have one, try contacting your local insurance office. Humana members can simply Google “Humana” and your city or town name to find the nearest one.
  6. If your agent is unable to help or you’re not able to connect with your local office, you can call the customer service line on the back of your insurance card.

Tips for better phone calls

  1. Stay calm and take deep, slow breaths if you feel your emotions start to escalate. When you’re calm, it’s easier for the person on the other end of the line to stay more calm too.
  2. Give the other person the benefit of the doubt. You never know what might be going on in their life. They could have just been through the wringer.
  3. Be as friendly as possible. As the old saying goes, you catch more flies with honey than vinegar. It could be easier to get the help you need and the outcome you’re hoping for when you are warm and open.
  4. Try calling first thing in the morning when you and the other person are fresh. You’ll likely have a shorter wait time as well.
  5. Take notes during the call including the time and date of the call as well as the name of the person(s) helping and what you discussed.
  6. You can ask to speak with a Case or Care Manager if you need to discuss a medical question. Often these jobs are held by registered nurses who may have more medical knowledge than the average customer service representative.
  7. Don’t be afraid to ask questions or for explanations. Insurance can be confusing, so if you don’t understand, be sure to speak up.

Your health. Your plan. Your choice.

When you educate yourself about insurance and your health plan, you’re more empowered. You know how to maximize the benefits of your plan and how to get help when you need it. When you see your health insurer as your health partner, you see how you and your plan can work together to achieve your health goals. By remaining calm and friendly when calling your insurer, you prevent interactions from escalating into conflicts. Your health and well-being are in your hands. You deserve to be healthy and happy. Your health insurer can help.

Getting the right plan is just one part of your healthcare journey. Finding the right care is another. Learn more.

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