Insurance Insanity

You cannot see me, but I'm plucking my lips making a babbling sound. I had another round of the "yes you do, no you don't" game.

I didn't write about this before, but this isn't the first time I've played this game. I'm laughing my head off, so thought maybe you would enjoy the round of this game I played today.

Last Wed the Medical Oncologist ordered two tests, they were scheduled for Monday morning, 1/2 hour apart from one another in two separate buildings across the street from one another at the same medical center. One a CT scan is considered a radiological test, the other a MUGA scan (at first I thought I was going to have another mugging...(mammogram) but no, this one is a scan for the heart) is considered a nuclear medicine test...I think. Anyway, they are both going to be performed by diagnostic imaging. My DH, being the forward thinking man that he is (when it comes to dollars) wanted to make sure the insurance was going to cover everything...so he called the insurance company. They wouldn't give him any information because the test was for me, privacy act and all that, but they did say "hypothetically" that they would cover the CT scan with only the doctor's orders, but I would need pre-approval for the MUGA. DH called me. I then called my buddy who handles referrals at our local clinic where our primary care physician (PCP) is. My PCP only works Tuesdays and Thursdays so she would be NO help with a referral as I would have to go in for the tests before her next working day. My buddy has helped me in the past and since the appointments are EARLY Monday morning, I knew we wouldn't have much time if I did need a referral. She didn't answer her phone, so I left a message then called the insurance company. Now mind you, it's 3:30 on Friday afternoon. The clinic closes at 5:00.

The insurance company had one of those automated menus and I listened and punched numbers through 5 (yes 5!!) different menus before I got a lady who told me I had reached the wrong department, gave me the number for the person I needed to talk to and then forwarded the call. That lady was very nice, looked in her files for me, I have my own e-file in the insurance company computer/ether. Told me I didn't have authorization yet, but that I didn't need it beforehand, and I would have 90 days to file any necessary forms if I went ahead with the tests before I had approval. Hm....doesn't sound right, but hey, that sounds easy. I'll take her word for it! I thanked her and got off the phone.

Before I could walk away from the phone, it rang. It was my buddy at the clinic. She asked me about the tests, told me one would have automatically been pre-approved, but the other would need pre-approval or I would be responsible for payment, and looking in HER computer, it was an expensive test. She told me SHE would call the insurance company and call me back. I thanked her and got off the phone.

Before I could walk away, the phone rang again. It was DH asking what I had learned. So I told him of the conflicting report. He told me to call the medical oncologist office and ask them to request pre-approval. So, I got off the phone with him and called them. I got an automated voice message that asked me to leave a message and they would get back to me. By now it was 3:45.

Before I could walk away, the phone rang and it was my buddy at the clinic again. She asked if I had a copy of the doctor's orders. I did!! She said she would fax it in and get pre-approval because she had called the insurance company and they definitely needed pre-approval. She had then called the medical oncologist to request a copy of the doctor's orders but she got an automated message to leave a message and they would get back to her. She didn't want to wait, because it was getting late, so wanted me to drive over and give her a copy of the doctor's orders...only problem is, I'm not supposed to drive. I told her I would call DH and I would call her back.

I called DH, he said he would leave work early, come and get the orders, take it to the clinic and let my buddy fax it in but while I was talking to him, the call waiting beeped, it was the medical oncologist office. They wanted more information about what I was asking about. I told them what they wanted to know, they told me they would call me back. I thanked them and got off the phone.

Before I could walk away from the phone, my buddy from the clinic called, said she had talked to the medical oncologist and they had told her THEY had contacted insurance and I no pre-approval was needed for either test but she was sure that was wrong, then she said she had an idea could she put me on hold. I said yes, but as soon as she put me on hold, the call waiting beeped and it was the medical oncologist office. I debated whether to answer or not, I would lose the connection with my buddy...but decided to see what the other office wanted. They again told me no pre-approval was needed, that they had told my buddy the same thing. I thanked them and got off the phone.

Before I could walk away, the phone rang again, it was my buddy at the clinic who had found a doctor to write a referral (which is in essence a pre-approval) for the procedure we were questioning and she had already faxed it into the insurance company. Bases covered!! It doesn't matter who was right about needing pre-approval, I have it now and so I'm set to go. Whew!! A few minutes later poor DH, who had probably driven like a bat out of H E double hockey sticks to get home in time to pick up the doctors orders to hand carry them to the clinic, arrived. He took the orders and drove over to the clinic and picked up the referral. DONE!! He walked through the door at 5:00, just as all the offices were closing. Talk about a close call. That's 90 minutes of my life I'll never get back...LOL I'm going to have to send my buddy a thank you card and flowers, don't you think? What would I do without her?

The scary thing is, I've been getting statements on a regular basis from the insurance company about how much they'll pay for each procedure...but today I got a bill from my medical center for the procedure (the biopsies) on March 29th (nearly 90 days later...remember the cut off date for submitting claims after the fact???) that they claim the insurance company hasn't paid. It was for over $1100.00!!!!! The offices are closed until Monday morning *sigh* I wonder what kind of phone tag I'll be playing Monday over this?!?! I'm afraid after the tests Monday I'll be reduced to a babbling idiot again. Oh well, it's FRIDAY...I can't do anything about it until after the weekend...so I'm going to take a few Valiums and kick back and pluck my lips in a babbling manner until then. Life is good! LOL!!