Communication with Insurers It can be one of the most frustrating parts of the job, speaking with the insurance company for your patient. There are times you just want to look at the phone and wonder, what planet are these people from? Insurers Goal Keep in mind that behind the person you are conversing with is under a team of executives pushing them to keep cost down. It may come across that the insurance representative is being unreasonable, however you must consider their job depends on their success in keeping those cost with reason. The insurance representative will have a series of questions they will refer to, and depending on the answers, they may insist that the patient can be cared for from home or a rehabilitation center. The representative on the line with you has a goal, and that is to cut cost. Insurance companies are not out to harm patients; however, the fact is, sometimes their decisions or lack thereof, does just that. An Insured Patient Mark was 45 years old when he was admitted to the hospital. He had a severe stomach infection and needed IV antibiotics for treatment. After treatment failed to produce results, doctors brought up the idea that surgery may be necessary to remove a portion of intestines that were infected. The process at that point was to wait a few days and determine if antibiotics were helping. Related: Obsessive Compulsive Disorder Facts Two days later Mark was no worse, yet no better, so the physician opted to wait, however the insurer was not in agreement. The insurance representative called the hospital and spoke with Mark’s nurse to question why he was still admitted. The nurse explained it was currently a wait and see situation. The insurance representative suggested that Mark return home while waiting, then follow up with the surgeon or primary care provider. The nurse explained to Mark that she was waiting for the doctor to call the insurer, and speak with a doctor there to explain the situation in its entirety. Mark was frustrated with his insurance company, and said if they wanted him to leave, he would just leave, which he did. Four days later Mark was re-admitted in very bad condition, and barely conscious. His infection had spread to his liver and throughout his abdomen causing major problems. An emergency surgery removed some intestines,
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