Monday, November 06, 2006

Health Careless II

Got a call from someone named Melissa, Melinda, Melanie, whatever, some minion of Maureen (yes, this tactless clerk has minions). She was calling to tell me that the claim that was submitted to Aetna for the three level replacement was ... wait for it ... denied. She started to tell me that if I wanted, I could appeal. That was when I stopped her.

"Listen, I think you are missing some information," I tell her. I explain that we already knew about the insurance company denying the claim, as we'd been notified last week when we got our online statement from Aetna, but we didn't sweat it because Dr. B. had just told us that he was resubmitting two new configurations to them that had a good chance of being approved (since we'd be paying out of pocket for some of it). I was more than a little concerned because

a) When we saw Dr. B. on the 25th, he said they were going to get to work on it "right away." A week later is "right away?"


b) Maureen and her posse are the ones that are supposed to be up on all the insurance company stuff! That's what they do, that's their job. How come they didn't even know that there had been a change to what was being submitted? It didn't sound to me like they were working in the same office I'd been in the previous Friday. It also didn't sound like any of the new configurations we'd talked about with Dr. B. had even made it to the insurance company yet.

MM (Maureen's Minion) shuffled some papers around and said she didn't have my papers in front of her (then why was she calling me? To recite the same gloomy crap she says to every one else?)but that she would "look around" and get back to me.

I hung up and called Theresa, Dr. B's NP. Normally I wouldn't call her, since she hates talking to patients, but figured I would get her voice mail and so wouldn't have to have any actual interaction with her and of course I was right. I told her that I'd been to see Dr. Balderston last Friday (like she hadn't seen me hobbling down the hall with my cane and looked right through me, yeah) and that we'd discussed resubmitting two new configurations of the surgery to the insurance company, and why did Maureen and her minions not know of it since they were the ones that were supposed to get working on it "right away" last week?

I also told her that she was to tell that whole office, Maureen and all of her minions, to lose my phone number, that the last thing I needed was these women calling with all this negative news on top of everything else. Just call me when you've got it together, ok? Why do I have to be reminded every step of the way that I'm being shafted by the insurance company? I gave her Tyler's number to call back as I'd just as soon not have her get back to me, adding that she didn't seem to anxious to talk to patients either.

About a half an hour later, Tyler gets a call from a very apologetic Maureen, saying that she had just gotten the paperwork (explaining the various steps in between my appointment and her and her minions) and that it would be submitted tomorrow. Since we are coming up on the December 6th date that Dr. B. had penciled in for my surgery, the absolute last date we could get approval and still make that date is this Friday, the 10th.

So now I'm in another set of knots waiting for Friday, wondering if they'll hear back from the insurance company in time so the surgery won't have to be delayed again, and if it does have to be rescheduled, let's hope, for all our sakes, that someone besides Maureen or her minions calls to let me know.

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Blogger HeroXJimmy said...

Absolutely amazing. I do not know HOW on earth you keep your head together through all of this.

Hero and Jimmy

8:46 PM  

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