The Queen of Denial

Maureen should not be allowed to talk to patients.

As I said here, according to Maureen, my clain with Aetna will be denied/rejected/refused/disallowed/declined. Then once I get the letter saying a resounding and predicted-numerous-times-by Maureen "NO," I have to decide how I want to appeal. Of course, as you may have read in the last post, this news threw me into a panic. I don’t know the first thing about appealing anything to an insurance company. Do I get an attorney? I’ve seen this kind of thing in movies and on Dateline, no one wins appeals against insurance companies!

So I asked Tyler to call and see what he could find out; he always has better luck getting info. For some reason, none of the staff in Dr. B’s office seem neither to want nor be even slightly equipped to actually communicate with patients. He spoke with the ever elusive Theresa, Dr. B's NP, who tried to immediately transfer him back to Maureen. Once he was allowed to get a sentence out, here’s what she told him about the whole process:

Every insurance company is rejecting any claim for more than one level of ADR. Once they reject mine, Dr. B has attorneys that will handle the appeal and on top of that, he sits on a board that advises insurance companies about the need for surgery, so he's confident that he'll be able to get two levels. In addition, he has several different permutations of the procedure that I need that will get appropriate payment for the hospital (such as charging a bit more for one disc to help offset the cost of the second, etc.) so that I will be assured of getting the two discs I definitely need. If worse comes to worst, Tyler said that we will pay out of pocket for the second disc (buy those t-shirts, people!). It’s all very confusing, not made any less so by the machinations we have to go through to get someone who will actually take the time to look at the big picture and then explain it to us. I guess it is really too much to ask to have someone be a little encouraging and optimistic when speaking with patients who are terrified and in pain, unlike Maureen, the humorless Queen of Denial.