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Stuck In Neutral

Tiffany Talbert Corbet

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I swear, two steps forward, three steps back. I'm usually known to be a patient person, but this is REALLY starting to test my limits.

 

So last Tuesay (7/31), I got the approval letter in the mail from my insurance that I am approved. It's assumed that the dr's office received one the same day and I would be hearing from them soon regarding scheduling the next pre-op tests. OF COURSE NOT! I was patient, and waited until Friday to call the dr's office (keep in mind, I have not talked to them, because they don't bother to return phone calls, since 7/17.....when I called them and found out they had not submitted my paperwork after waiting a week for my psych results they had not requested after THEM scheduling me on 6/10 for the appointment!) {deep breath}

 

So anyway, I call and the coordinator actually answered the phone (it's 90% the part-time receptionist. I think the coordinator hides from me). I told her that I had received the approval letter on Tuesday and was just calling to find out what the next steps will be. "We haven't received a letter from your insurance. Perhaps it's in the mail and I haven't seen it. I'll go back through and see if it's there. If not, no big deal, I can call the insurance company and get the code needed to move forward.". Ok, cool, no big deal. I didn't not hear back (of course). So I called yesterday, and they said they still had not received the letter and insurance told them it was in "nurse review". (This is where I call bulls***.) So I got off the phone with them, and called the insurance company (UHC) and tell them the dr's office has told me they have not received the letter. She tells me that's odd since it was mailed out on 7/24. (UGH) So I get the reference #, and the website they can go to and print the letter out from there. I call the dr's office back, and get the receptionist again and give her this info. She takes it and my cell #. Do you think I've heard a peep out of them!? HELL NO!

 

I need a patient advocate, because my ends are about frayed and I can't be responsible for not blowing my cool the next time I talk to them. Are we really sure it's always the insurance companies in the wrong, and not just incapable workers in the dr's office? This is driving me NUTS! I'm going to need the psych all over again when this is finally done just to get rid of my murderous thoughts.

 

Ok, one more time.....UGH!



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Hi Tiffany,

I know your pain. Trust me. Some of the people at these facilities are either A) over worked, or B) barely working. Who knows, it could be a little of both. I too had to personally handshake the communications between my medical provider and the surgical center. But unlike you, I didn't wait patiently. After they dragged their tails once, I didn't expect anything more. So, from that point forward I held their hand for every process. And it's a good thing too. When it finally came to getting the approval for the surgery, the center sat on their hands for two days. After two days I picked up the stick and called them and informed them to submit for approval because my Dr. already cleared me two days prior. Then I kept calling back to see if it was done. The next day I called my provider and they informed me that they never received any request for authorization. Soooo, I called the center and stayed on their head again. Then they wanted to tell me that it was already sent to the provider for approval. But I already had the 411 and so I told them that it was NOT sent over for approval, per my provider. Then they were like, "Ooooo, I'm sorry, I guess it wasn't. Welll, the girl who works on those is extremely busy and it can take her up to a week to prepare that paperwork before she can forward it for approval." WTH!! What are doing, writing a business proposal?! Anywho, two days later I called my medical provider and they informed me that they had received the request for approval. The next day is was approved and so I called the center who informed me that they had not received it yet. I informed them to go to the Web and pull that authorization. Three hours later, it still was not done. So, I had the provider fax that authorization to me and in turn I faxed it to the center. Then they informed me that the person who sets the surgery appointments was "out till tomorrow" Ugggg! Of course I called day and got it done. But that what it takes sometimes.

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That's just rediculous! They make all this money for these procedures, and I KNOW those people are getting paid better than minimum wage. Why can't they hire KNOWLEDGABLE, CAPABLE people!? I'm probably in a bad position to view this, being an ex-General Manager at McD's and now an Exec Asst to senior management (and yes, I may have a slight case of OCD), but how may patients do they do this to? I know I'm venting, and probably boardline whining, but really..... :)

Thanks for letting me know I'm not alone.

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For sure. I'm glad I could help. But to add insult to injury... becasue of their slow response throughout, I was authorized two weeks later than I could have been. And becasue of that two week delay, I bumped heads with the Doctor's scheduled two week vacation. Therefore, my surgery took place one month later than projected. To think, I probably could have been 20+ pounds lighter right now :(

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I've worked in insurance 10+ years and can tell you from my experience, we don't sit on paperwork. We have print outs and spreadsheets tracking everything we do. Any correspondence is time stamped and every company has turn-around-time goals. If something gets "old" we're going to be asked what the hold up is. When it comes to pre-approvals, on our end the hold up is with OUR medical staff.

Why is that? IDK. Doctors run on their own time, I think.

And as far as your doctors office not getting back to you, I'd ask if there's an office manager and speak to that person. If they can't help, then tell your surgeon that their staff is irresponsible with returning phone calls. That's not a responsible way to run a practice, and the MD should be aware if an office manager is unable to resolve the issue. I would normally err on the side of patience as well, but when you're lied to (i.e. them saying they didn't get the letter/it's still in nurse review) that's the end of being patient! Did you offer to fax a copy of yours to them? It should have most of the same info...

In any case, try to keep your cool, but don't lay off hounding them to get their jobs done.

good luck!

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I have considered several times trying to get to someone who is a supervisor, but it seems there are 3 office workers, the nurse practitioner and then the pt, dietician and surgeon.....so I think I'm probably already talking to whomever would be considered the "office manager". I did call them again this afternoon (even though I hate being thought of as a pest) and got one of the 3 I have spoken to. She asked if she had just called me. I'm not sure if she did because the first number listed is my home number and I was at work. So she asked me to hold and went to talk to the coordinator. Then she came back and said that they had called the insurance and no one had returned their call (I just don't buy that) and asked if I could fax the letter to them. I said sure, give me a fax number and I'll fax it as soon as I get home (I'm lucky enough to have a printer/fax/copier compliments of my employer at home) so I faxed it right after I walked through the door and put my briefcase down. Any bets on how long it will be before I have to call them again to get an update?

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Oh, and the plan is to not mention anything about the organization of their office team until after the procedure. The hospital sends out surveys after each visit, so I figure that's my best opportunity to let not only the Dr's office know the issues, but the hospital as well so it can be elevated and have a light shined on it in hopes some changes are implimented. Part of me wants to go in and teach them how to be organized and efficient, but then I have my own job (and a side job) that keeps me busy enough.

(I should have known this was going to be a communication challenge when the coordinator couldn't be bothered to put the fax machine tech on hold and continued talking to him all while we were finalizing paperwork when we were leaving after the surgeon consult.)

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It has always been my experiance to be yanked around by the insurance company. Decided I would not let them stress me over this surgery. Guess what? I took out $$ from my 401k "hardship loan" and went the self-pay Mexico route.

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It's sad when we have to be made to feel like a pest when we just want a surgery date!

I hope it goes better for you from here on out, good luck!

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Things are looking up. I faxed the letter to the Dr's office and confirmed they got it this morning. Moving forward finally.....endoscopy scheduled for 8/21 at 2 p.m. :) Persistance paid this time!

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