Thursday, November 06, 2008

Early Morning Insurance Battle

Generally, I don't have a lot of complaints about our insurance. It's a point of service plan that requires stupid referrals but b/c our primary care doctor is very flexible giving them out, it isn't too bothersome. And because I work for the state, it's pretty well priced and 100% coverage outside of the copay. But, I do find it exceedingly annoying that I have to keep getting new referrals for the same doctors we see over and over. So except for one slip up about 2 years ago, I'm very good about getting referrals. I usually call a few days before an upcoming appointment to our insurance to make sure the referral is still good just to be sure that we don't end up having to pay more than we should. So when Caroline and Bryce had an appointment in early October, I called because while I was pretty sure Caroline's was valid, I didn't think Bryce's was. But, the woman I spoke with on the phone, said that it was good through the end of May. That didn't sound right to me so I asked again and she verified that I was fine for my next visit. (This is where having 3 kids and having to remember everything comes into play since I figured I certainly COULD have gotten Bryce a new referral in the spring and not remembered it.)

Then when we got to the allergist for the appointment, I was told by the office staff that they had a fax from my insurance (on their letterhead!) that said our plan didn't require referrals. WHAT? So basically, they saw that his referral was no longer valid, but because they had this fax, they didn't tell me because they figured it was okay. I made sure to get a copy of this fax and contacted the insurance the next day. They seemed totally confused about it and had me fax it back to them which I included a cover letter and asked for some clarification - which I've yet to get. So we had another appointment yesterday and I made sure to get a referral for Piper but was still operating under the assumption that Bryce's referral was valid through May 09.

Then we get home. A statement from the insurance company that says he was NOT covered for his early October visit b/c there was no referral!! WTH??? I was fuming. And then I realized his visit from yesterday wouldn't have been covered either. Soooooo, as soon as I walked in the door this morning I called and navigated through the most annoying voice recognition phone system. At least now I know how to ask for a representative very early on so I can get out of that stupid queue. And as luck would have I got a seemingly competent representative on the phone. Using my most assertive voice, I explained the story to him and told him that when I called in early October I was told that my son's referral was still good because if they had told me it wasn't I would have gotten the referral. I have a history of getting them, so why wouldn't I have done it??? So at this point, I don't know if he was trusting me at my word or he could see in the system that I had indeed called because he told me that he would contact my primary doctor for the referral himself and get it resubmitted along with yesterday's visit. I made sure to get his direct number/contact so I can check in on it next week.

I still haven't gotten any clarification on this mystery fax sent to my allergists, but at this point, it's neither here nor there since I will continue to get referrals no matter what some fax says.

I was cautiously triumphant when I called Jason to tell him and won't feel 100% better until all is said and done. Working in an office that does a lot of paperwork, I know that mistakes happen so I understand that and expect that someone will fix it when it's realized. It's just reconfirmed to me how important it is in these days to stay on top of your records and to be your own advocate because no one is watching out for you but YOU. At least the 2 doctors offices that I have to deal with in this situation are generally flexible and helpful, so that makes it a lot easier.

1 comment:

Mama said...

Been there, done that...many, many, many times and it sucks. I hate dealing with insurance companies. They love to give the run-around and you are right, no one looks out for you but YOU. I imagine they sit in a little room and laugh at all the people they screw.