Health Front: Insurance Calls are Recordable. Do it!

By DR. JERRY DeCAPUA

In a recent report by the Los Angeles Times, Anthem Blue Cross was caught red-handed distorting the truth after denying a surgical procedure. David Cienfuegos, age 40, had his wife contact Anthem Blue Cross to make sure that the procedure he needed was covered by his Blue Cross policy, and that his doctor was in the Blue Cross physician network. The phone call to Blue Cross seemed to have verified that he did indeed have coverage, but after the operation he was left with $5,800 in medical cost when Anthem Blue Cross insisted that it never approved or verified that it would cover the service charges.

Anthem Blue Cross now says that he must have misunderstood the Anthem Blue Cross representative and he is now responsible for the entire medical bill. The patient appealed to Anthem Blue Cross and was turned down again on February 19. In that denial letter, Anthem Blue Cross states that, “No specific provider was mentioned in the conversation, nor was it noted you were misinformed about participating status for this specific provider in question.”

But the issue did not end there because Mr. Cienfuegos had recorded his wife’s original conversation with Anthem Blue Cross, and his attorney now has a CD copy of the real conversation that was clear as a bell. So, Anthem Blue Cross is now being sued for lying to their subscriber, as well as billed for medical expenses. Cienfuegos’ attorney expects Anthem Blue Cross to settle out of court.

“Anthem could not go to trial on this because a jury would kill them,” notes his attorney.

Mr. Cienfuegos states that, “If Anthem Blue Cross can record the conversation for quality purposes, so can I.” And yes, you can.Very few patients are savvy enough and prepared to record such a conversation. But it may not be hard at all. One action you might take is to Google Voice all insurance verifications — Google Voice is a free service and call recording is also a featured free service.

Most states require the other party to consent to the recording, but if the insurance rep tells you no, you definitely don’t want to deal with that rep anyway. When you notify that you would like to record the conversation for quality purposes you want to sound amenable and nonthreatening. Make it a pleasant request.

Even though you may think that appeals may never win, statistics actually show the opposite to be true. Over 60 percent of all appeals win. But sadly, only eight percent of patients appeal. There are often exceptions to insurance policies that are not properly available to the insured party. Particularly, if a network provider is not close by, or it’s an emergency where you can’t travel all the way to a network provider.

Something as important as an assurance or authorization for a medical procedure should be recorded and put on a CD. It is a slight inconvenience to learn one more technical tool or computer application. But today’s insurance is not quite the insurance you think it is.

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Date
June 1st, 2014

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