Tuesday, March 2, 2010

Sorry, I Need a Rant

Really, if I don't get this out, I might just explode. It's about this person in my surgeon's office. I have a condition that has to be monitored via CT scans every six months. Well, the past two times I've had the CT scan, this office person neglected to get pre-authorization from the insurance company. Insurance company was relatively nice about it, saying once they received the proper paperwork from the surgeon's office person, they would "post-certify" the procedure so it would be covered. After they did this the second time, I received a tersely worded letter from said insurance company saying that any future procedures NOT pre-authorized, would NOT be covered. Period. Got it. Really this should not be an issue as I am pretty sure most US insurance companies require this in some form or fashion.

So, I call office person (this is December-ish) and ask what needs to happen to be sure my next CT scan is pre-authorized because I do not have $3,000 to pay for this out-of-pocket. She assures me that she will get the pre-authorization and not to worry. OK, but I am going to worry because you didn't do this the previous two times, and I do not have $3,000. Well, I can call her a week before the CT scan. I can do that.

And, so I called last week. Office person informs me that it is February and my procedure isn't until March. She works March procedures when it is March. I comment that my procedure is March 3rd and my insurance company (via letter to me) indicated it would take 48 hours to get the pre-authorization. Oh, but it never takes that long, office person assures me. Umm, yeah. Office person generously allows that I can call her the day before my procedure. I hang up the phone grumbling many unkind words under my breath, but I put a note on my calendar for March 2nd to call office person.

Oh well, lookie! Today is March 2nd. Yes, I called office person (I refuse to dignify her with an actual human name) at 11:00 am today (my CT scan is 8:00 am tomorrow). OK so she'll call my insurance company and call me right back. WHAT?!?!!?! I remind her that the letter I have from the insurance company says that they need 48 hours to approve. She tells me that it never takes that long and hangs up. OK, I'm over the fact that you hung up on me because I figured out how rude you are the last time we spoke. But, it is quite obvious that had I not called you today, you had absolutely no intention of getting my pre-authorization. I'm actually proud of myself for not snarkily reminding you that it is indeed March now, and my procedure is scheduled for March. That should meet your criteria for action, but apparently not so much.

I will give office person a half point for actually calling me back (but I do think she realized I'd be calling her back had she not) an hour later to tell me she was able to get the pre-authorization on the phone and had faxed the number to the hospital. Oh, there is a number? Can I have the number? You don't need the number, the hospital does. I realize this. (Pardon my extreme paranoia, but I DON'T HAVE $3,000!!!! I DON'T TRUST THAT YOU DID WHAT YOU SAID, AND I WANT TO BE CERTAIN I WILL NOT HAVE TO FORK OUT $3,000. ) I do not say out loud what I am shouting in my head as I am trying to take the nice approach. But clearly, office person does not get it. She tells me she does not understand why I am so persistent about this. Well, because had I not called, you would not have done your job, and it's really important to me both because I need insurance to cover this procedure, and because I have a potentially fatal condition that has no symptoms and can only be monitored via this procedure. According to "assistant doctor" office person (apparently she got promoted while on the phone with me) because it's been six months since my last CT scan, my condition cannot be very serious and it would not be a big deal if the procedure had to be canceled. Therefore, I have no reason to feel there is an issue. Really. What planet does she live on, and will they please take her back?

I tried once more to explain why this is important to me (I don't have $3,000, and I'd like to make sure my aneurysm doesn't burst and kill me. Really pretty simple.). I ask again if I can have the pre-authorization number. She again tells the hospital already has it so I don't need it. She further tells me that it is all my fault anyway for having the insurance company I do. Apparently this insurance company never used to need the pre-auth., but now they do. She rattled off to me the list of insurance companies needing pre-auths. I was so impressed. Office person goes on to tell me she sees no further problem and hangs up on me. Gotta love that efficiency. I bet she passed the third grade.

No one at the hospital seems to know who is the keeper of pre-authorization information. I did call to see if they have it. Insurance company couldn't get past that I am not a doctor calling for a pre-authorization. They just couldn't grasp the idea of a patient calling to see if a pre-authorization had been obtained. I'll try asking in person tomorrow before they actually do the procedure, but I think I am just going to have to take it on faith and see what happens.

Next week, when I see the surgeon for the test results, I plan to let her know what happened. I also plan to tell her that I want my medical file to take with me when I leave as I will be finding another surgeon to be responsible for my care. While I don't feel strongly one way or the other about the surgeon herself, I won't be treated this way by her office staff. I see them as a reflection of the surgeon. If the office staff does not think patient care is important, then perhaps the surgeon does not either. I live in a city with one of the best teaching hospitals in the US. I promise there are lots of competent surgeons from which to choose. I plan to find one who also hires nice office people.

If you read all of this, thanks for sticking with me. I'll get over it. I am sure part of the reason this beyotch got to me is because I'm a little sensitive right now. I mostly don't think about my aneurysm except when it comes time for the CT scan. It's disconcerting to think you have a time bomb ticking inside of you and there is no way to know when it will go off, if ever. But, if it does, your dead. I do realize that there are people who live with this condition most or all of their lives without issue. But, the medical profession has no clue what causes this type of aneurysm, what makes it worse, or what makes it better. No clue. So, karma should really cut me a break when I'm forced to think about it.


  1. {{{Cheryl}}} - I know it's a little late now (as the procedure is tomorrow), but I find that putting something *in writing* has a far better response. I would have sent the surgeon's office a copy of the letter from the insurance company a couple of weeks prior to the appointment, via certified mail, with a reminder that you have an upcoming appointment, and that your insurance company requires pre-authorization. I would further state that if they fail to get the said pre-authorization, that you refuse to pay for the procedure out of pocket, and ask what steps they need you to do to ensure that the surgeon's office remains in compliance with the insurance company's requirements.

    I'm sorry that you have to deal with incompetent people. I hope the procedure goes smoothly tomorrow!


  2. Ditto what Susan said. And that you can find a surgeon who hires nice office people.


  3. ((Cheryl)) what a collasal PITA that shouldn't have been necessary at all. That office person sounds like she is a little bit of a know-it-all who is actually a walking example of the "little bit of knowledge" is dangerous adage.

    Hope your procedure goes well.

  4. Take a deep calming breath... and use it to scream at them very loudly when they tell you they're going to charge you $$ for a copy of file.

    They'll send it to a new office for free (professional courtesy - not kidding), but you they will charge.

    And I agree, get thee a new doc!

  5. Wow, what a pain!!! I've got my fingers crossed that everything goes okay for you tomorrow (both with the pre-authorization and the scan).

  6. So, to summarize: Office chickie is blaming you for having a medical condition that requires observation, is blaming the insurance company for requiring documentation and is annoyed that you're asking her to get the documentation filed in a timely manner (ie do her job). What a peach.

    Godd luck today. I'm thinking good thoughts for you!

  7. Cheryl, you are in my thoughts - and you know why. I can so relate to your trials regarding that aneurysm and the procedure with insurance and CT - I am sitting in a comparable boat since last May...Take a deep breath - and try to not get too hot with anger ! Hugs, and good vibes ! kind regards, Martina

  8. PLEASE tell me that you're going to use your blog rant as the rough draft of the letter you hand deliver to the hot little hand of your surgeon (otherwise office chickie will just throw it away). I can't believe how much TOTAL BULL this is, and how angry I am on your behalf.

    I'm looking forward to your follow up post on this matter. Grr!