|Ten to Four
by David Cunix
The call came in at ten of four. The client was both agitated and apologetic. He hated to bother me, but he didn't know who else to call.
John and Mary (names changed) have Medicare Advantage coverage through a major carrier. They have had ample opportunities to see their policies in action.
Mary's doctor ordered a heart catheterization for January 8, 2015. There is a whole pre-procedure protocol for a non-emergency catheterization, including a change in medication. Mary was doing her part. But now, less than 24 hours prior to her appointment, the doctor had called to advise her that the pre-certification had not been finalized. No pre-cert, no insurance payment.
John called the insurer and got nowhere. Which insurer? Truthfully, it doesn't matter. I can't say why this case fell through the cracks. I don't know if the doctor's office was the issue. What I can report is an aggravated client, a nervous husband, calling about a procedure that needed to be done.
I promised to see what I could do. I called the insurer. We're agents. We have different numbers. We have access. My contact needed a narrative in an email. That email was time stamped 4:09 PM.
Final resolution, including notes in the client's file, was achieved by 5:11 PM. And I was able to reassure John and Mary that their health insurance was going to help them receive the care they needed.
The government has no idea what we, licensed insurance agents, do for a living. And, in truth, our insurance carriers don't always fully appreciate the part we play in the system. But we know that it is the agent that not only takes that frantic call late in the afternoon, it's the agent that gets the problem solved.
After the November 4th General Election, the Ohio Legislature will conduct its "lame duck session" that is scheduled to occur between November 12th and December 18th. Any bill that does not pass into law this year will die and a new two-year session of the Legislature will start next January with new bill introductions.