The Invisible Trophy

I won't win a trophy today for what I did, but I'm fine with that. Working behind the scenes in insurance in the position of customer service phone representative is a challenging, frustrating and often high stress job as I try to assist members who have issues accessing medical care to get prior claims paid.

Today I interacted with a cancer survivor who has multiple life issues dealing with a claim that denied. We ended up talking a short while about her overwhelming challenges at home and this claim, denied as investigative was entirely too small to be her biggest concern, but I helped her understand her benefits and her appeal option. I ended the call with a deep respect for this lady and said a prayer for her and her family. My reward was having had some positive influence in her life and commending her on her strength. My kindness brought her to tears and a temporary connection to someone who cared. She thanked me as we ended the call and the call left me with a sober feeling for her unique struggles.

Another call surrounds claim I encountered last night. This issie is a hot mess. I interacted last night with a widow regarding a second appeal problem for claims for her deceased husband stemming from January of this year and the many brick walls she has scaled to try to help her deal with and escalate her questions to the appropriate people and escape penury.

Today I received word via email that someone higher up in the company is aware of her plight and once more and is trying to help her cope with the $2M in balance billing charges coming from invisible out-of-network surgeons who are not accepting the insurance company reimbursement we mailed to her. Balance billing occurs when out-of-network medical providers bill members directly since the providers aren't bound by our insurance contracts and go after the member for the remaining money owed to them.

The widow has three surgeons who treated her now deceased spouse trying to get that money and she feels trapped. Who wouldn't? I hope my actions result in some form of help for this poor woman.

My job can have a great deal of impact if I can get the appropriate attention to an unsolved problem. It's ultimately her deceased husband's former employer's decision on how much the employer group pays the doctors because the employer is a self funded group, meaning that the company pays for their own member's claims rather than a large commercial insurance company or Medicaid.

The group says yay or nay to paying. What employer really wants to shell out millions of dollars for one deceased member for three specialists the widow owes?

I just picked up the baton where someone else dropped it almost a month ago and sent a high alert regarding the widow's frantic inquiry and expiring appeal options.

No, there are no trophies for customer service representatives and sometimes not even a thank you, but I go home knowing that I helped one more person connect with services they need or with others who can ultimately help them get rid of a burden.

Many of life's rewards come without cash or applause but the longer we live we appreciate that one person who truly listens and wants to help another human.

People need people and at my job I will try to be that person who listens and takes the extra time to get the answers a member needs.

God has a way of coming back around again.

"Do what you can, when you can, for who you can.*

SRC

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