There is a healthcare crisis in this country. Whether you like Obama's proposed resolution to these difficulties or not, the crisis is very real. And HMOs can be the most difficult of the current types of healthcare to deal with. You don't have to search news stories very long to hear about people who were denied essential treatment when their lives were on the line, or had treatment postponed so long because of bureaucratic red tape that their conditioned worsened beyond medical intervention.

While many of us won't face these kinds of struggles with our health insurance, most of us will, at one time or another, have to struggle with our insurance company over payment approval, referral approval, or any one of a myriad of other common issues. Here are some tips to help get insurance issues resolved as quickly as possible with a minimal hassle.

Talk to a Person

Many times, the number on the back of your HMO card or the one that's available online will take you to an automated system where it's difficult or impossible to get an actual person on the line. Websites like gethuman will help you figure out how to navigate this system so you can talk to a real, live human being. If your problem is at all unusual or difficult, talking to a person and not a machine is essential, as messages are much easier to lose or ignore than a person with a voice and a story whose questions the employee actually has to answer. If you do choose to leave a message the first time, do not assume that the issue is dealt with. Call back and get a person if you don't hear anything within a couple of days, letting them know that you're following up on your message.

Keep Records

Every time you talk to your HMO, or someone at your doctor's office about your HMO, record the date, day, and time you made your call, whether you got ahold of someone or had to leave a message, the name of the person you spoke to, any different departments they transferred you to, and anything relevant that the people you spoke with said about your problem. This may seem like a chore, but these records can help you in a myriad of ways. You may realize that you're speaking to a person that you've spoken to before, and your notes will tell you whether or not they were helpful last time and whether they followed through with anything they might have said they'd do for you. Records also allow you to say, "Yes, I called on [date] at [time] and [date] at [time], etc.," which will often let the person you're speaking to know that this is an ongoing problem.

These records will also serve you well if you ever have to file an official complaint against the insurance company or contest something they say. If you have records of having called to deal with this issue on certain dates and at certain times, they can often check call records or even recordings to find your calls. If you have records of who you spoke to and what they said they would do for you, the insurance company can further investigate the situation with specific employees.

While keeping records won't guarantee that your claims and complaints are handled well, they will help you get the information and give you the leverage that you sometimes need to get things done.

Be Polite

Health insurance companies, like other corporations, are beginning to make notes in files about how cooperative and polite different customers are on the phone. If you're known for having good manners, you're more likely to get the help you need, get passed on to a supervisor if you request it, and deal with people who are willing to go out of their way to help you. It's definitely worth it to develop a good reputation with these companies.

Ask for a Supervisor

If the person who answers the phone can't help you, or if you've spoken to someone at a particular level several times and your issue hasn't been resolved, ask to speak to a supervisor. Sometimes, they will put you through directly. Often, a supervisor has the authority to do things that the ground-level employees cannot do, or they know details of procedures that those employees won't know.

Other times, it will be company policy not to send you directly to a supervisor. In these cases, however, the employee you're speaking to will usually be required to forward your request to their supervisor even if you don't get to talk to them. Ask for this and let them do it if they offer, get specifics on when you should hear back from the supervisor's office, and get the supervisor's name. If you have to call back again, you can ask for the supervisor by name, which is often enough for them to let you speak to the person. You can also say, "{Supervisor's Name} was working on an issue for me and I'm following up on it." Unless you're dealing with a particularly difficult triage system, this is usually enough to get you through to someone who will be more helpful than the person who answered the phone.

Ask When to Call Back

End every conversation by asking when you can plan to see some resolution to your issue, or when you can call back to expect an update. You can even ask if the person you're dealing with has a direct number so you don't have to go through the receptionist every time. If you don't see any resolution by the date they gave you, or when it's time to get an update, call back and try to speak to the same person you were speaking with before. Remind them who you are, what the issue was, and what they told you about resolution or calling back. This will streamline your process, and will also let the employee know that you're serious about dealing with the issue and are not just going to let it go.

Call Back Frequently

If the employee you're speaking with refuses to give you a date of resolution or a date to check back, call back anyway. Most companies take about 2 weeks to process any changes, so give them about that much time before you call back. If you do this for a period of time and still nothing is resolved, call back more frequently. Every week, every other day, and even every day are viable options. Sometimes, you just have to keep nagging the insurance company before they'll act on an issue, particularly when acting will cost them money. But the squeaky wheel does get the grease, and if you annoy them enough (politely, of course!), then you're more likely to get some response.

Don't use this tactic too early, though. If you make a nuisance of yourself before you've truly given them the benefit of the doubt and not seen a satisfactory response, you'll be labeled a nag and the employees will be less likely to help you. Taking this route involves walking a fine line. Pay attention to the employees' attitudes and the way they speak to you. If they're trying to do their jobs and you're simply not giving them enough time, back off for a week or so.

This is also a good technique to use when a particular employee, especially a lower-level one, refuses to give you what you need or pass you on to a supervisor. Call back later that day, after normal business hours, on the weekend, or the next day and, chances are, you'll get a different employee, who may very well be more helpful to you.

Use Names When You Call Back

If you're keeping records, the first time you call should be the only time when you cannot ask for an employee by name. Having a specific person to ask for immediately marks you as someone who cares about your problem, is more likely to be tenacious in getting resolution, and has enough presence of mind to be keeping track of your conversations. All of these characteristics will make you stand out from the crowd, which will make it more likely that you see some resolution.

Having a name also helps you develop a relationship with a particular employee or group of employees. Sometimes, resolution can be a product of one employee who knows your problem, some of your story, and begins to care for you beyond the normal customer, enough to go our of their way to see that you get what you're looking for. Asking for an employee by name and discussing your problem with them repeatedly can help develop this kind of relationship.

Resolution

In the end, health insurance companies are all about money. If you want them to spend more money on you than they think they should, you will be facing an uphill battle. While the above ideas don't guarantee a resolution to your problem that you like, they do give you a better chance of finding a happy ending to your problem. I'd love to hear any other tips and tricks you've used when dealing with your HMO, so leave them in the comments!