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As a part of your responsibilities, you are answering the phones for the day. An angry...

As a part of your responsibilities, you are answering the phones for the day. An angry patient calls and begins yelling at you about an EOB that she has received that denied her claim as being “not medically necessary.” It will be important that you attempt to listen to the facts the patient is giving. How would you handle this situation?

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Answer #1

I would politely apologize to the woman and request her to explain to me calmly what had happened earlier. After gathering all the facts and information from her, I would ask her to wait as I transfer the case to my senior. I would also assure her that we would be ready to help her in any manner possible for us and then hang up. I would then transfer the case and details to my senior officer and assist him in deciding what steps to take next which would ensure full justice to the woman as well as compliance to the insurance policies.

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