Tips for Calling Your Health Insurance Company

Whether you’re questioning how much you owe on a doctor’s bill or confirming whether a specific treatment or drug is covered, there are plenty of reasons that you may need to call your health insurance company.

Unfortunately, that can be a frustrating process. More than half of consumers are dissatisfied with experiences they’ve had with their health insurer over the phone, according to a recent report from Forrester Research.

While interacting with your insurer can feel overwhelming – especially if you need to discuss an issue that’s complicated or confusing — you can make the communication go as smoothly as possible by following these simple tips.

DO prepare for the call ahead of time.

Look over your insurance documents so that you know exactly what your plan covers. Have your insurance cards and other documents in front of you before you call your insurer. If you don’t have itemized medical bills, ask for these from your doctor.

“Take the time to write down the things you’re hoping to discuss, the answers you want, and what kinds of information you’re seeking,” says licensed health insurance agent Christian Worstell in Raleigh, NC. “Then check off each item as you go through the conversation, so you’re not talking yourself in circles.”

DON’T call on Monday morning.

Because many medical events happen on the weekends, Mondays tend to be the busiest times for insurance call centers, says Brad Cleveland, a consultant on customer strategy and management based in Sun Valley, ID. Mornings are also typically the busiest time of day, he says, so you may get a less frazzled, more attentive representative if you time you call for an afternoon later in the week.

DO take detailed notes during the call.

Write down the time and date of the call, as well as the name and employee identification number of the person to whom you speak. Jot down any actions that they agree to take, and follow up with an email or fax reiterating the highlights in writing. Ask for specifics, when possible.

For example, if the insurance company denies a claim, ask them to share a reason for the denial and point you to the section of your insurance policy that confirms the denial as legitimate, says Gail Trauco, an oncology nurse and patient advocate in Senoia, GA, who founded Medical Bill 911, an online course on dealing with medical bills.

DON’T forget that you’re dealing with a person doing their job.

As frustrating as you may be with the situation, yelling or losing your temper will not help you win over the agent. It’s normal to feel emotional when you’re dealing with money and with medical issues. But if you’re feeling particularly stressed, wait until you’ve calmed down to call your insurer.

“You can be assertive when you’re calling on behalf of yourself or a loved one,” says patient advocate Ailene Gerhardt of Brookline, MA. “But don’t be aggressive. Be cooperative.”

DO give the agent a chance to help you before you escalate.

While it can be tempting to ask to speak with a manager right away, many of the front-line service representatives have the authority and expertise to handle most common calls, Cleveland says. Since the managers tend to be stretched thin, helping many agents, you may have better luck working with that representative.

“Often the agents have as much or more experience than their manager,” Cleveland says.

DON’T expect to resolve complicated issues right away.

If you’re calling with a question or issue that may require input from your doctor or insurance experts, you likely won’t get a resolution on your first call. Before you hang up, make sure you’ve confirmed the next step and when you’ll hear back from the insurance company. Ask for the best number to call if you have follow-up questions.

“Sometimes there’s a different number than what’s printed on your card, or if it’s very involved, you’ll have a specialized person or group working with you,” Cleveland says.

DO ask for help if you need it.

If you’ve followed the above steps and still feel that you haven’t reached an acceptable resolution, you may need to bring in backup. In some cases, your doctor’s office or hospital can support you. Otherwise, you may want to team up with a patient advocate through your workplace benefits or hire one yourself to help make your case.