So, as it turns out, due to some strange things going on with his teeth, CJ needs to have some surgery done.
When we first met with the oral surgeon in December, he hadn't seen the x rays yet (I think the office may have lost them) and they couldn't find the letter sent to him by our dentist. He spoke in general terms about what would need to be done, and said he would request another x ray from our dentist and call me in a few days. He felt that we could schedule the surgery for spring break.
Several weeks later I still haven't heard from him, so I call the office to check on things. About an hour later, the doctor himself calls me. He has just looked at the x ray (? just looked at it?) and feels like this really can't wait until spring break, and we should have the surgery right away.
I speak with the office staff who gets us on the schedule as soon as possible which ends up being 4 weeks later.
That would be 28 days. (remember this number)
I assume everything is OK, and we make arrangements for the surgery to be Feb 20.
Last week, I get a call from the office telling me what the estimate for the surgery will be, what our insurance will cover and how much we sill have to pay. At the time I received the call, I was half asleep, dealing with a super nasty headache and the numbers didn't really sink in until DH came home and I told him about the call.
The numbers were all wrong, because we knew darn well that our insurance would cover more than what the office girl said.
DH called our insurance. They had no record of anything being submitted for an estimate or pre approval from their office.
I called the Oral surgeon's office the next day.
Me: "We spoke with our insurance because we're pretty sure that they will cover more than you quoted, but they couldn't tell us anything for sure because they've never received anything from your office."
Office girl: "Yes, we submitted that. We just fax it in, and they fax us back a copy of your benefits and we figure it out."
Me: "They have no record of that."
OG: "Well, I can submit it again"
Me: "Please do that."
The next day, we call the insurance. Still no record of anything being sent. We also learn that we need to get a pre authorization before the surgery.
I call the office again.
Me: "Our insurance still hasn't received anything from you, and we need to get pre authorized before the surgery."
OG: "Well, it says right here that it was sent."
Me: "Well, they still don't have any record of it."
OG: "I can send a pre estimate, do you want me to do that?"
Because basically, that was what was supposed to have been sent in the first place. (and what I thought had been sent)
This week. Insurance still doesn't have any record of anything being sent.
I call the office. Again.
Me: "Our insurance still doesn't have anything from you. Did you send the pre estimate?"
OG: "Yes, but we haven't received anything back."
Me: "We also need to get pre authorization before the surgery. It's scheduled for this Friday. That's only three days away."
OG: "Hmmm........I guess what I can do is call the insurance company and give them the dental codes over the phone."
Me: (sarcastically in my head "could you really?")
Me: (out loud) "Yes, that would be great. Please do that."
OG: "I'll do that and call you back."
The next day, she calls me back.
OG: "I just spoke with your insurance, and got the pre authorization over the phone."
OG: "And your insurance won't cover any of the anesthesia."
Me: "According to what I just read in our benefits, our insurance will cover 80% of anesthesia."
OG: (giggling) "Well, that's kind of tricky. They might cover it, and they might not. It just depends on whether or not they find it dentally necessary."
Me: "My son is 6 feet tall and nearly a black belt in karate. I'm pretty sure the doctor will want him asleep for this, because if he's awake, he might fight back."
(and just between us, I've met the doctor, and I'm pretty sure CJ could take him)
OG: "Well, they also said they won't cover the rest of the surgery until they see the x rays."
OK, the surgery is in two days, and she's just now finding out that they need to send x rays to the insurance?
This doctor is a preferred provider with our insurance. One would think that the office staff would know the insurance policies.
So today we call the insurance and find out that they do indeed need to see the x rays before approving the surgery, and it may take up to 20 days after receiving the x ray to approve the surgery.
Which is tomorrow.
We call the office. They are sending the x rays today.
Now if you do the math, I scheduled this surgery 4 weeks ago, plenty of time to send x rays and allow for the 20 day approval time from the insurance.
I just called to cancel the surgery for tomorrow. OG was annoyed. Especially when I asked her WHY the x rays hadn't been sent earlier.
OG: "Well, sometimes they don't require it."
YOU ARE A PREFERRED PROVIDER THROUGH OUR INSURANCE COMPANY!!! YOU SHOULD HAVE KNOWLEDGE OF THE BENEFITS, AND YOU SHOULD KNOW WHEN THEY REQUIRE X RAYS!!!
So, I just rescheduled the surgery.