Managed Care Essay

586 Words3 Pages
The world of Managed Care can be a complicated place. There are many stakeholders that benefit form this part of health care running smoothly. It doesn’t matter if you are doctor, pharmacist, lab tech, family member, or a primary member of a managed care or insurance indemnity plan. No matter who you are, when you contact a managed care company, you expect member services to handle you concern in the proper manner. Member services or customer service in health care is not like other customer care teams in other industries. The training and vocabulary that is needed to do the job of these types of individuals do on a day-to-day basis is intensive. Often times the training consist of weeks of medical jargon and law compliance procedures.…show more content…
The most common practice for managed care member services is to have strong customer service department. A good trained customer service department can mean the difference between paying an expensive claim and not paying a claim. The customer service department can handle many tasks. One of the main reason different callers contact member services is for plan information and verification of plan coverage. Member services have to be abreast of the different plans offered from PPO’s, to CHDP’s. These plans can offer different options of coverage depending on the size of the employer or if it is an individual plan the coverage may be standard. These individuals have to understand a great deal about insurance and how it works. The wrong coverage information given could cost the managed care company thousands and even millions of dollars. The issue with this type of communication is that so many people are calling at one time; no one is getting good customer service, because it becomes a race to answer the next call. Therefore, this practice should be handled by priority and the most urgent should have a different number to call and the least urgent should use an automated system. The other common practice for member services is mail. The biggest issue practice with this is the long process. In many cases health information is not only urgent but also sensitive, and the mail is not the best

More about Managed Care Essay

Open Document