Don’t Grow Old on Hold

Over the past few years, online methods for contacting your Medicare Advantage insurance company and other service providers in our tech-driven world have grown exponentially.

While communication options like AI chat systems, email and online portals are convenient for some, they don't always suit the older American population. Website emarketer.com reports that just 35% of people aged 45 to 75 prefer to use digital options; the other 65% opt to make that phone call to a customer service center.

A phone call to your Medical Advantage insurance company provides personal assistance and allows you to explain your situation in detail, especially more complex issues. A call also allows you to ask clarifying questions and to ensure nothing gets lost in translation. Good customer service representatives bring empathy, active listening skills and creative problem-solving to the table — qualities that virtual systems often lack.

When you dial your Medicare Advantage insurance company's customer service number (usually found on the back of your insurance card, labeled "Member Services" or "Customer Service"), you will likely encounter an Interactive Voice Response system, or IVR. While navigating these systems can be frustrating, listening carefully to all the options will help you choose the most relevant one.

• Some companies allow you to say keywords like "representative" or "customer service" to bypass IVR menus. You can also try pressing the "0" key repeatedly to reach a representative. These hacks do not always work, as IVR systems act as a screening tool to determine the nature of your call, whether it concerns enrollment, authorizations, benefit information and so forth. The time it takes to carefully select the correct option can save you time as your call progresses.

• Have your Medicare Advantage insurance ID card ready when you call.

• When prompted, enter your member ID number (which is on the front of your Medicare Advantage ID card), your date of birth and your zip code. Making the effort to enter this information accurately is also a time saver.

To minimize hold times, keep in mind that the following times can mean longer hold periods before you speak to a representative:

• Mondays or Tuesdays.

• The Medicare Advantage annual enrollment period, from October 15 to December 7.

• Medicare Advantage Open Enrollment period, from January 1 to March 31.

• The day after a holiday.

Congratulations! You have successfully navigated the IVR system and reached a representative. To ensure a productive conversation:

• Have a pen and paper ready to write down information or questions.

• Minimize background noise. Silence loud TVs, music and radios, and move away from other loud noises in your environment.

• To ensure optimum audio quality, speak directly into your phone or your earpiece rather than using the speaker option on your phone.

• Avoid calling from a car, as your call quality can be impacted by engine and traffic noises. You also run the risk of a disruption of cellphone service, due to spotty coverage which can cause your call to drop.

• Speak slowly and clearly. If you can't hear or understand the Medicare Advantage representative, don't hesitate to ask them to slow down or to speak louder.

• Before you need help, make sure you have either an Appointment of Representative (AOR) form or a copy of a power of attorney on file with your Medicare Advantage company. It must authorize the named person to speak on your behalf. If needed, a representative of your Medicare Advantage plan will send you an AOR form or give you information on how to return a copy of your power of attorney.

• If there's no AOR form or power of attorney document on file, the representative will ask the caller to verify key details, including your name, date of birth and member ID number. A representative will also ask to speak to you to obtain your verbal authorization, giving the caller permission to speak and act on your behalf regarding your plan. Note that a verbal authorization is valid only for that call, so providing relevant documents can alleviate a lot of frustration for future calls.

In all of these situations, Medicare Advantage insurance companies are required to protect your privacy by adhering to HIPAA (the Health Insurance Portability and Accountability Act of 1996) and PHI (Protected Health Information) guidelines.

Note: if you have a Medicare Advantage plan in Maine, state law dictates that a representative must speak to the customer directly or the customer must have a power of attorney document on file to be able to speak to someone with a power of attorney if they are calling on your behalf. Representatives are not allowed to speak to anyone else who calls on your behalf, whether or not an AOR form with their name on it has been returned.

When explaining your question or issue to a Medicare Advantage insurance representative:

• Be clear and concise about the purpose of your call.
• If discussing a claim, provide the date of service, name of the provider (the doctor, specialist, nurse practitioner, imaging technician or other medical professional who provided the service) and any relevant billing details. Have the provider’s phone number handy in case the Medicare Advantage representative needs to contact them.
• If you’re inquiring about a procedure or a service, ask your provider beforehand for the procedure code(s) and share it with the representative. Mention where the procedure will occur (doctor’s office, imaging center, outpatient hospital), because believe it or not, this can affect your co-payment amounts.
• When checking on the status of a prior authorization that a provider has submitted on your behalf, give the name of the provider or facility, the date it was submitted and the procedure or the reason for the authorization, so your representative can locate it effectively.

If your issue requires further research or outreach to a provider, the representative will schedule a follow-up call with you to advise you of updates or resolutions. Specify whether they can leave a voicemail message if you're unavailable and provide your best call-back number.

As your call concludes, ensure all of your questions are answered and expectations are set for any necessary follow-up calls, mailed documentation or emails. Do not hesitate to request clarification if something is unclear.

Keep in mind that you have rights during your phone call.

You have the right to:

• Request the representative’s name. and to obtain the call reference number.
• Expect periodic check-ins if placed on hold.
• Receive clear explanations of your benefits, claims, plan details and to all other questions.
• Ask for documentation, such as your Evidence of Coverage, your Summary of Benefits, a list of in-network providers, a drug formulary, claim and reimbursement forms, and much more.
• File complaints, grievances and claim appeals.
• Have your concerns escalated to management, if necessary.
• Most importantly, you have the right to be treated with respect and professionalism.

The good old-fashioned phone call remains a powerful option with which to connect with a Medicare Advantage insurance representative who cares about resolving your issues. Your representative is there to help, and by following these suggestions and knowing what to expect on a call, you can make the process smoother and less stressful.

Julie Van Dyke is a freelance writer in Las Vegas. She possesses extensive knowledge about Medicare Advantage and Medicare Supplement insurance plans, and serves as the front line of support, assisting thousands of callers each year in her member services role at a major U.S. insurance company. Read More