inside hacks or tips for getting past phone gatekeepers

December 13, 2024 6:23 PM

I'm a cancer patient who needs to make frequent calls relating to my medical treatment. These calls are to: health insurance and dental insurance companies, hospitals/medical providers (including behavioral and various specialists), and medical device companies. The struggle to actually get the help I need on the phone is making my life markedly worse, and I would like concrete suggestions.

The first human to pick up has a 99 percent chance of not being able to solve whatever is going on (my questions relate to making/switching appointments, incorrect billing/payments, insurance coverage, prior authorization, in vs out of network, Rx medication refills, and similar) and are almost always confused about the policy and reluctant to get their supervisor on the line (sometimes they say there is no supervisor/manager there).

They give canned, useless responses (likely AI generated) and then may "connect me" to someone else, and that's when the call either disconnects entirely or I get routed to a voice mailbox, leave a message, and don't hear back for a week if at all. It's incompetence and delay all the way down.

What is the cheat code here? What are the magic words I need to say to speak to someone knowledgeable, and most importantly, someone who has the authority to help me right away? (Assume that I already have communicated via email or patient portal when that's an option). Reminding people of my cancer hasn't worked.

I've noticed that, sometimes, once I've seen a specific doctor or therapist in person a few times, they give me access to their direct number, email address, or even personal phone, and this is usually the only scenario where I'm able to get care and help efficiently. How can I get this sort of information faster?

posted by CancerSucks to Technology (17 answers total)

“agent” to anything automated.

"i understand you'd like to speak to someone, if you'd..."

“agent”

"[computer]"

agent
posted by HearHere at 7:08 PM on December 13, 2024 [2 favorites]

I'm amazed that you're doing this all yourself. I helped my mom when she had cancer and I currently help my disabled sister. I can't imagine someone with a major illness doing this on their own.

It sounds like you need a patient advocate. Hospitals typically have patient advocates, so you might ask your hospital if you can speak to one related to issues you're having with the hospital.

Also, I googled and found Patient Advocate Foundation. I'm not familiar with this organization, but it sounds like it has the potential to assist you.

The PAF website defines a patient advocate as:
"A person who helps guide a patient through the health care system. This includes help going through the screening, diagnosis, treatment, and follow-up of a medical condition, such as cancer. A patient advocate helps patients communicate with their health care providers so they get the information they need to make decisions about their health care. Patient advocates may also help patients set up appointments for doctor visits and medical tests and get financial, legal, and social support. They may also work with insurance companies, employers, case managers, lawyers, and others who may have an effect on a patient’s health care needs. Also called patient navigator."
posted by SageTrail at 8:11 PM on December 13, 2024 [6 favorites]

Edit: The definition of patient advocate that I posted is actually from www.cancer.gov
posted by SageTrail at 8:25 PM on December 13, 2024

For years I had to call multiple dental insurance companies daily. I got good results with saying “representative” (instead of “agent” but that probably would work also). You can usually say it without waiting for the automated voice to finish their sentence. There was at least one company (MetLife?) that had the “ press 1 for … press 2 for … menu. If there is a number for “For all other questions press…I would choose that number (seems like it was often “6”). If none of the choices sounded good I would try “0”. If the automated voice said that was not a valid option I would pick an option that was not correct but was most likely to get an actual person, like a billing question. If the representative was just a low level employee reading from a script I would let them get all the way through the script then politely thank them for their help and ask if I could speak to a supervisor. They won’t transfer you unless they can show that they did everything they were supposed to do, so don’t bother asking for a supervisor right off the bat. I always was nice and thanked them for their help. I have heard they put you on hold longer if you are rude and aggressive or threatening.
posted by LiverOdor at 8:41 PM on December 13, 2024 [1 favorite]

I live in the UK and have a disability that can impact my communication skills. For a number of providers I use for things like gas and electricity supply, mobile phone contract, banking, and I seem to remember there are others, I am registered with their accessibility service. This gives me a separate number to call regardless my enquiry and connects me with a person with special training to help people with disabilities navigate their systems. I wonder if such a thing exists for services you are using.
posted by Erinaceus europaeus at 8:49 PM on December 13, 2024 [3 favorites]

Not exactly what you're asking, but yeah, do you have a friend who'd like to help with this? My bestie was in full-time cancer treatment for 5.5 years and I made approximately ten thousand phone calls on her behalf. I was happy to do it, seriously, and it took a large burden off her.

In full honesty, in many cases I pretended to be her, because with various privacy rules the provider/biller/whoever wouldn't talk to me otherwise. I made appointments, dealt with billing, got test results, etc. The system is stupid and messed up but I took the burden off my friend at least.
posted by BlahLaLa at 9:12 PM on December 13, 2024 [6 favorites]

The cheat code is to call your Senators’ and Congressman’s offices and explain how much your qualify of life sucks thanks to medical and insurance companies running gaslighting phone scams on you. It would be helpful if your friends and family did so too. I suspect this is not quite what you had in mind but other posters seem to have the more direct answers in hand. Best of luck to you in life.
posted by Gilgamesh's Chauffeur at 9:34 PM on December 13, 2024 [6 favorites]

If you know the name of the person you need to talk to, select the option for "Accounts Receivable" or "Billing" (the departments that collect the money tend to be well staffed and thus should answer quickly) and then when they pick up say "oops I pressed the wrong button" and ask them to transfer you to so-and-so.

On a lot of phone systems, internal transfers like that take priority and show up differently on the caller ID.

Source: I used to do business-to-business collections and had to learn tricks to reach people who were dodging my calls.
posted by Jacqueline at 12:43 AM on December 14, 2024 [23 favorites]

I have a deep hatred for phone trees and hiding behind them. This is not a solution for many and does not directly answer your question, but when I get beaten down by the phone tree, I just show up in person at the office. I tell them I am willing to wait. Then I just stand right by the desk until someone in authority comes out to answer my questions.
posted by JohnnyGunn at 2:22 AM on December 14, 2024 [5 favorites]

In some cases (pharmacies, clinics, medical equipment companies) there may be an extension to press if you're calling from a doctor's office. Press that then play dumb if they ask why you pressed that extension.
posted by latkes at 5:36 AM on December 14, 2024 [5 favorites]

From the details you give about the nature of the calls you have to make, I’m assuming you have health insurance. All major health insurance companies offer care management for their members. This is usually a nurse who works with folks to help provide education, care coordination (appointment scheduling, benefits verification) , and can absolutely help internally with smoothing the way for prior authorizations. If you haven’t already been approached about enrolling in a care management program, call the number on the back of your insurance card and tell the rep you want to be assigned.
posted by little mouth at 6:28 AM on December 14, 2024 [10 favorites]

Amen to Jacqueline's suggestion above. Related to that: Be sure to have the name of any supervisor or manager or senior person, so you can always be routed directly to them when you call.

Also, ask for a confirmation number or reference number for your call. It may help shorten waits a bit.
posted by yellowcandy at 7:41 AM on December 14, 2024 [1 favorite]

If you can find out who is the company outsourced to do the prior auths for your insurance company, you may be able to find PDFs for guidelines. This is most useful for getting prior authorizations pushed through as they will give the internal reasoning used by the non medical people hired to do these. For instance, one can find Navicore head imaging guidelines, or Medicare CMS testing guidelines by CPT code.
posted by cobaltnine at 7:52 AM on December 14, 2024 [1 favorite]

I am sorry you are dealing with this. I recently had a similar issue with my state health connector, and I was able to track down an ombudsperson for the organization to help me. I was given a specific number and email that I could contact until all my issues were resolved. It took a while to track down the information, and the first option was to write a letter and mail it in! I then found a link for an email form. I would google to see if you can find one for the organizations you are dealing with. Another place to check is Reddit- it is one of the last places on the internet where folks share their experience and information about specific issues, and I have found many work arounds there.

I would also check to see if there is a someone in the hospital/treatment clinic that can help you with some of this- they want to get paid, so they usually do have someone to help navigate the issues.

The other thing that I would offer, is that for the most part the low level folks you are talking to have no say in the organization or management of the company they work for, which you most likely know/understand, and I have found just expressing that fact and asking to be escalated can help move the process along. "I have called 5 times already about this issue. I understand that you, as the first point of contact can't help me with this issue, through no fault of your own. Could you escalate my call to a manager or case worker who is authorized to help me?"
posted by momochan at 9:08 AM on December 14, 2024 [1 favorite]

As a nurse in a specialty clinic I dealt with these systems a lot. I can confirm that selecting the option for “calling from a doctor’s office” or “I am a medical provider” will get you prioritized. I recommend writing down the ‘paths’ you end up taking to get to someone in each system so you can repeat it— I used to have papers taped up on the wall with number sequences for the phone trees of different companies and it was a huge time saver.

For medical providers, you can also ask their nurse or medical assistant if they have a direct line. I used to give mine out regularly to patients who were having difficulty navigating the larger health system I was part of.

Finally, even when your call ends with someone decidedly unhelpful, it’s worth trying again another day. Different employees, even within the same system, can have vastly different levels of knowledge and willingness to help. I recognize that this is exhausting and may not be feasible while you deal with everything else on your plate. Like others in the thread, I recommend asking friends and family for help with this if it’s at all possible for you. I’m so sorry you have to deal with this.
posted by bookish at 10:41 AM on December 14, 2024 [5 favorites]

Sometimes cursing at the IVR system will get you a human.
posted by neckro23 at 5:37 PM on December 14, 2024

Recounting the entire history of your current quest seems to have helped me recently. If you can find a way to do that which doesn't entirely destroy your will to engage -- quickly, with humor, whatever works -- that's probably going to help.

You need to convince the person on the other end that you are different and that you know that their canned response won't work. They have dealt with a lot of people who are sad, angry, intelligent, tired, and sure that they're right -- none of that will break through. Only the details of your story will demonstrate that you have traveled the number of miles you have traveled.

That, and -- MeMail if you want my other hit-or-miss strategy (I'm not keen to have it slurped up by bots).

Love,
amtho
posted by amtho at 10:57 AM on December 15, 2024 [1 favorite]