By Angel MedFlight Contributor
Imagine life on the front lines of the Angel MedFlight claims department. Hardworking team members on the phones with insurance companies steadfastly laboring to get a patient’s claim paid in full. As one can imagine, this constant tug of war can be taxing. But thanks to some recent implementations, the claims department is finding more effective and fun ways to get results and strengthen our commitment to patient advocacy.
First some explanation of what our claims department does. Number one, it must make sure claims are submitted to the insurance company and submitted correctly. Chief Strategy Officer Cassandra Graper says the claim must reflect the services the company provided. Secondly, the department must follow up on those submitted claims and make certain they are processed in a timely manner according to government regulations. “If they have 30 days to give us a response, you make sure that a response is given within 30 days and that they don’t go over that time,” says Graper. Finally, our claims department makes certain claims are given a fair and full review by the insurance companies.
Graper says it’s important to investigate the plan language to make sure the insurance company actually referred to plan language in that denial. Who denied it? Was it a medical professional? What is their medical background? Do they have a specialty in anything? What documents were reviewed to reach the decision? “We make sure that all the information we provided to the insurance company was used to make their decision. If it’s not, that’s not a fair and full review,” says Graper. When asked if she thinks consumers would be surprised at the number of claims that do not get a fair and full review, Graper responded with an emphatic “Yes.”
The Angel MedFlight claims department sets team goals and now Graper says, there are fun ways to keep track of those goals. By using a specially designed web application, team members in the claims department can see real-time results posted on an electronic display in the office. Our team members see fireworks displayed on a big screen when a payment is made. And when a claim is paid in full, the retainer is given back to the patient.
The leader board application that has been implemented helps boost morale, motivates our claims department members and helps boost performance. When goals are reached, team members see animated displays of a soccer ball hitting the back of a goal’s net. These displays bring a smile to the face of the employee and motivate another employee to see what he or she can do to achieve the performance of the person next to them. But Graper points out that success of the team is paramount and that any added performance by an individual only boosts the success of the team. Graper says she saw the same results in the flight coordination department and thought it would be beneficial in claims as well.
Graper says the battle with insurance companies can be taxing and the real-time leader boards and fireworks on the big screen in our claims office help promote a “healthy competition” and “keeps team members motivated to keep pushing.”
Angel MedFlight Worldwide Air Ambulance is committed to patient advocacy. “It’s easy to take no for an answer” from insurance companies, ” says Graper. “We don’t.”