How to talk to an adjuster

When you deal with insurance companies, you are bound to hear a lot of excuses from adjusters concerning why your claims have not been processed. Here are some suggestions on how to respond to the three most common excuses:

1. Excuse: “I didn’t get your claim.”

• “Stand by your fax; I’m resending it right now.” Then call back in 15 minutes to confirm the adjuster got it.

• “When can I expect a check?” Put them on the spot.

2. Excuse: “That’s as good as I can do, you’ll have to wait” or “We‘re backed up.”

• “That’s not good enough!”

• “Let me talk to your supervisor.”

• “When can I expect a check?” Get a definite date.

3. Excuse: “Your claim is in review.”

• “Where in the review process is my claim?”

• “Let me speak to the reviewer.”

• “Is the reviewer a peer or licensed DC in my state?”

• “What is his/her number? I’d like to speak to him/her.”

• “When can I expect a check?”

• “Are you aware of the lawsuit regarding bogus paper reviews?”

• “State law says you have 30 days to pay or deny.”

• “We sent a tracer out more than 10 days ago. Why don’t I have an answer?”

• “If we can’t get this resolved today, I will assist the patient in filling out a complaint to the state insurance commission.” Or, “I’ll be assisting the patient with retaining an attorney.”

• “I believe we have a case of bad faith and failure to perform here.”

• “Are those limitations specifically enumerated in the patients’ policy? What page? Fax me a copy.” Or, “Fax the patient a copy at this number.”