DEAR ABBY: My letter is prompted by my frustration with insurance representatives with no medical knowledge. I am a physician, and am frequently asked by my patients to write or call on their behalf regarding a medical bill that the insurance company has denied. Many times, I am just repeating what the patient has already said to the claims person. Other times, I am engaged in disputes with claims people who don't know what they are talking about.
Recently I was explaining a disease process to an insurance representative when she haughtily informed me that she had taken a medical terminology class. Perhaps she is able to spell "nephrophthisis," but I believe her scope of knowledge ends there. Since I don't know how to fix cars, I certainly wouldn't argue with my mechanic about the automobile engine.
My colleagues report similar experiences. My patients share horror stories. I would like to hear an explanation as to why insurance companies employ people who handle claims in subjects about which they are not knowledgeable. -- FRUSTRATED DOC, UTICA, N.Y.
DEAR FRUSTRATED DOC: I suspect it has a lot to do with cost containment. If a medical professional were handling the claims, it might drive administrative costs through the roof; and if a debate actually occurred between two medically knowledgeable professionals about whether a claim should be paid, the company might find itself paying out more fees to doctors. I'd be interested in a response from insurance companies -- if it is short, sweet and to the point.