Most revenue cycle teams have asked this on at least a few patient calls:
“Can you call your insurance and ask them about this balance?”
It happens when a claim has processed but the balance looks off, even if there’s no clear reason to appeal. Or maybe the EOB doesn’t really answer the question everyone seems to have. Staff don’t feel comfortable interpreting benefits or speculating, and the account is sitting in a gray area between insurance responsibility and patient responsibility.
It feels reasonable to ask the patient to call. After all, the patient is the member. If something’s unclear, shouldn’t they be able to get answers directly from their plan?
In practice, however, this almost never moves the account forward. It’s just one example of how patient collections outcomes are shaped well before outreach begins.
What Actually Happens When Patients Call
Almost everyone has had the frustrating experience of speaking to their insurance company; the outcome is usually no different in this case. Patients wait on hold, explain the situation to one rep, then possibly get transferred and explain it again. They receive answers that sound definitive but don’t align with what the hospital told them. Often they’re told the provider would need to fix it.
Ultimately, the balance doesn’t change. Patients come back with some version of, “They said this is how my benefits work” or, “They said you’d need to contact them about it.”
The issue isn’t resolved, and from the patient’s perspective, the system appears fragmented and evasive.
Why These Calls Don’t Change Anything
Patient-insurer calls are operationally designed for explanation, not resolution.
When a patient calls their insurance, the payer can describe benefits, confirm what the EOB shows, or restate how the claim was processed.
What they typically can’t and won’t do is change it.
This is because patients don’t have the access to trigger reprocessing. They can’t correct how benefits were applied, they can’t escalate contract interpretation issues, and they can’t dispute system logic errors. Even if the conversation is thorough and polite, the outcome is purely informational.
So, the balance stays exactly where it was and the bill remains unresolved.
What to Watch for In Your Data
If your team is doing this, you’ll see it as friction across multiple places:
- Accounts sent to patient pay that stall after “insurance follow-up”
- Repeat patient calls on the same balance without any claim changes
- Notes that bounce between “patient advised to call insurance” and “patient still confused”
- Aging that increases without a denial or appeal ever being filed
- Balances that eventually get written off without being corrected
One way to surface this pattern is to track how often accounts reach patient pay while insurance questions are still open. When that number is high, patient collections struggles often follow, because responsibility moved downstream before resolution happened. Teams that lower this number usually see fewer repeat patient calls and less aging without changing scripts or cadence.
Conclusion
When a balance is stuck because of an insurance question, the fastest way forward is usually for the provider to make the call.
That sounds counterintuitive when teams are already stretched thin. But in practice, one provider-to-payer conversation often takes less time than weeks of stalled accounts, repeat patient calls, and restarted follow-ups. Patients can only get explanations, but providers can get action.
Even when the answer is “nothing can change,” knowing that early lets the account move instead of lingering.
Think of it this way: If your team is circling the same balances downstream, that time is already being spent, just less productively. Better to make the call at the outset than to create more work down the line.
