Frustrated with third party administrators?

[moonlightandmargaritas]

Brutal - I can understand your frustration.

I personally have had a lot of luck having the client request that the records be faxed to me, if necessary. Keeps you in control, and many hands out of the pot...

 

[LGilmore]

Actually most md's offices are awaiting the check that comes with the aps request. Most of the ones I deal with will sit on the information till they get paid. Average turnaround for an aps is about 40days.

That includes having the insured call. 20 years ago three weeks from app to policy was considered a long one. Now, I'd kill for that. The blessing of technology..information at lightening speed delivered as slowly as possible.

 

[ABC]

This is all part of the underwriting process.

A lot of the time I am motivating other people to do their job so I can finalize a case.

From a health standpoint I will use carriers that can complete a case in a month. Once you starting hitting that 45 days to 60 days its time to evaluate carriers.

Also if you writing an app and you see multiple health conditions with multiple Docs. you should know what coming next.

On the life side I tell the client the process is going to take at least 60 days.

 

[Colorado Newbie]

I've only been in this business for a few years now and I have heard time after time that the one of the biggest shortfalls of the health care industry is the handling of medical records and how incredibly wasteflu it is in terms of time and money involved.

I'm starting to understand why this is. And the more I see the more disgusted I am. Health insurance company wants EMSI to request records. EMSI contacts a 3rd party company to get the records. 3rd party company gets in touch with field rep to get the records. COMPLETE CLUSTER F%$@ of a system.

I am reminded of the old addage of If you want something done right you do it yourself!

 

[moonlightandmargaritas]

I am reminded of the old addage of If you want something done right you do it yourself!

Yup, that's why I do it the way I do.

Service is so bad, and so many back offices are so pathetic, you've got to do everything within your power to avoid screw-ups.

An example: I recently received some "above and beyond" service from one of the major health insurance carrier's CSRs. Very professional.

I hunted down the "manager" of the CSRs to tell her of the outstanding performance of one of her team members. I was also trying to get their email addresses so I could commit it to writing...got into her voicemail and left her a message.

She never called me back.

 

[Colorado Newbie]

I am so frustrated at the moment about this whole process of getting medical records!!!!!!!

1. Application submitted on 11/09/08
2. Medical records requested 11/11/08
3. Medical records recieved 11/20/08
4. 2 pages received were bad. records requested again 11/25/08
5. called doctors office 11/28/08 to let them know request was coming for 2 pages to be resent
6. I noticed 12/12/08 that the insurance company is still waiting on medical records.
7. I called docs office on 12/12/08 and they have yet to recieve any request for medical records.
8. I call EMSI on 12/12/06 and they claim to have contacted Health Port to get the records on 11/28/08 (Health port is the company that the docs office uses for recording medical records)
9. I call Health Port on 12/12/08 and they say they have not recieved any new request for medical records.
10. I try calling Health Port again today (12/16/08) and sure enough they recieved a request for the medical records during the afternoon on 12/15/08.
11. Health Port tells me that they have sent the person that retrieves medical records. They also inform me that this person has 1 week to go by docs office to get them.

Ok, I admit that I should have kept a much closer eye on this. This would have never taken this long to clear up had I been on the ball with this one.

However, this is a good example of how messed up the system really is. Their are a total of 5 different hands in the pot. How can anyone expect to get good service from or health care system when they are counting on 5 separate initities to actualy come together and work flawlessly?

So yesterday Golden Rule finaly recieved my clients medical records.

I think next time I get "it's not our fault" from everyone involved I am just going to put them all on conference and let them discuss it amongst themselves who's fault it is that nobody is doing anything to get my clients medical records.

 

[Colorado Newbie]

Update to my last update....

Uhm, I just checked GR and to my shock and horror they are again requesting medical records. 2 pages keep coming back to GR enlarged way too much and they cannot read anything.

My fuse is getting very short with this........

 

[insuranceexec]

EIS, or ESA??? Anybody know what this is - is somebody spamming here promoting something? I wish I understood why people post vague things like this....

Not spamming, my post was already corrected by the next postee; Colorado Newbie.

EMSI is the company my secretary uses for myself and my agents; and she says that it works very well. Hopefully now it is within your comprehension level