Keeping cool when someone is shouting at you is not easy, but it is certainly part of the patient access role. Recently, Denise Williams, COC, CHRI, led a group meeting on how to remain calm under trying circumstances. Staff listened to this recorded call:
Caller (calmly): I just received my statement. I need to know why I received a bill from the hospital asking for payment from me. The hospital must have billed something wrong, and I need that corrected.
Team member (calmly): In reviewing the notes, your insurance company says your contract does not provide coverage for this specific service.
Caller: That is wrong. My doctor said it would be covered. The hospital must have done something wrong when the claim was filed.
Team member: I see that your doctor’s office called and spoke with the insurance company prior to the service, and there was a precertification number provided.
Caller (interrupts and voice is raised): See! It was covered, and the hospital messed everything up!
Team member (trying to remain calm): A precertification number is issued based on the information that was provided prior to the service. It indicates the insurance company was contacted prior to the procedure. It doesn’t guarantee that the insurance will pay 100%. That is dependent on the terms of your contract coverage. If something changed during the service, that could change the amount of coverage provided by your insurance.
Caller (yelling): That is a crock! You are just trying to cover up the hospital’s error and make me pay more than I should have to pay!
Team member (trying not to get defensive): No, ma’am, we are not. We work from the information that your insurance company provides to us based on your contract. You need to check your individual policy. I will ask our coding department to review the documentation again as a double-check.
Caller (loudly): Just fix it! I don’t owe you anything, according to my doctor!
“We took this conversation and dissected it,” says Williams, senior vice president of revenue integrity services at Raleigh, NC-based Revant Solutions.
Coworkers agreed their colleague said all the right words. Yet it was obvious the employee still was not able to defuse things. “We need to recognize when a caller’s voice is rising and be sure that our voice stays calm and serene,” Williams says.
Employees shared their own personal tricks to accomplish this:
- Think about sitting on the beach;
- Imagine every caller as a parent and the consequences of “back talking”;
- Squeeze a stress ball;
- Take a deep breath, and say to oneself: “I will not get upset. He/she doesn’t understand what I understand.”
“The team member involved in the call was grateful for the insight, and hadn’t considered these,” Williams reports.