Customer Service – Understanding Health Insurance, Part 3

Customer Service


Previously on the Reflex blog, we discussed out of pocket costs and preauthorization, as they relate to your health insurance coverage. Today we’d like to cover another common question: Where should you turn when it comes to insurance questions?


While most people have a tendency to call the doctor’s office, the most efficient route to immediate answers is to contact your insurance company directly. In reality, your medical office serves as the middleman between the insurance company and its policy members – and (like the patient) is often waiting to hear back from the insurance company regarding claims processing and approvals.


It can be difficult to navigate conversations with insurance companies, so we’ve compiled some information on how and when to make the call.


How to Make Contact


On the back of your insurance card you’ll find a customer service phone number designated specifically for members. These days, many companies have instituted automated phone programs that can help you check basic information – such as your deductible, out of pocket maximum, co-pays, or general coverage for in-network providers. If you need more detailed information (such as the status of a claim or pre-authorization), you’ll need to request to speak to a representative directly.


This same basic information can often be found on your insurance provider’s website. Look for a website address on the back of your insurance card – many insurance companies have patient portals. Setting up an account login the first time you visit the website usually only takes a few minutes.


Questions to Ask Your Insurance Company


Ask your insurance company directly if you have questions about any the following topics:

  • Whether a specific provider is in-network with your plan
  • The status of a submitted pre-authorization (pending, approved, denied)
  • Information regarding claims submitted to your insurance provider by any medical office you’ve received treatment from
  • Your Explanation of Benefits (EOB), which details how much your insurance company will pay for services, and how much will be left for you to pay
  • Billing inquiries
  • Requesting a Summary Plan Description, which details the benefits, limitations and maximum for your plan

Speaking with an insurance representative will help you to address these questions and clear up any confusion surrounding your plan.


How Reflex Does Our Part
At Reflex, we try to make the insurance process as easy as possible for our patients. Here are some steps we take to help:

  • We call and verify eligibility and benefits for all new patients scheduled for an initial evaluation.
  • We provide a Reflex insurance specialist at the end of your appointment, who will review your insurance coverage for any new treatments recommended by your physician.
  • We call insurance companies to verify coverage for patients scheduled for six-month follow-ups. In these calls, we determine whether your insurance company has made any changes to your policy. If so, we will notify you of these changes during your visit.

If you’re struggling with knee pain, insurance can often feel like one more obstacle in the way of relief. Don’t let insurance questions overwhelm you – knowing your resources is the first step to finding answers and moving forward toward a pain-free life.


If you are struggling with chronic or intermittent knee pain that is affecting your daily life, call to schedule an appointment with one of our specially trained physicians today at (503) 719-6783.

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