Thursday, February 19, 2009

The reason why I feel like beating my head against a wall. Again and again and again and again.........

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?"
Me: "YES!"
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."
Me: "Great!"
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."

WHAT????

OK, the surgery is in two days, and she's just now finding out that they need to send x rays to the insurance?

Seriously?

This doctor is a preferred provider with our insurance. One would think that the office staff would know the insurance policies.

YA THINK???

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.


For March.


Spring break.

24 comments:

The Boob Nazi said...

ARGH! I feel you. Insurance companies are pooheads sometimes. They don't cover an autistic kid's therapy sometimes because they think he's just fine. SOOO irritating!

b. said...

This kind of incompetence/laziness REALLY gets my dander up.

I'm sorry.

Musings of the Mrs. said...
This comment has been removed by the author.
Musings of the Mrs. said...

I felt like my last comment may read the wrong way, so I deleted it. What I wanted to say was that I feel your annoyance, I am annoyed for you. I have had so many of those types of things happen the empathy I feel is making me want to bang my head against a wall. UGH!

Annette Lyon said...

If a mysterious package shows up at their office, I won't say a word. And I so wouldn't blame you.

rychelle said...

you could always use the twinkie defense when you go postal on that office.

Me said...

I don't know what I would do without insurance..but sometimes...dealing with the insurance company and the doctors office and everyone inbetween can be a real joke! For the sake of YOUR sanity, I hope it goes smoothly from here on out!

Kristina P. said...

Ooooh, I love Rychelle's response. Definitely you need to go postal. Have CJ wear his Snuggie while doing it.

utmomof 5 said...

It's like they hire the dumbest people possible to deal with insurance companies. We had one alot like that at our pediatricians office. Makes you want to scream!! (Okay so I actually did scream at the one at our pediatricians office, good thing we moved cuz I think we may have been asked to find another pediatrician!!)

Hope it is smooth sailing from here!!

Help Que and Brittany Adopt said...

This is why I don't go to the dentist. :p

The Littlest Hillbilly: said...

I am so glad I am not the only one who has problems like this. You would think they would know stuff like that. Our health insurance is through the hospital/doctor's office we go to and they still get it messed up!

Alison Wonderland said...

Oo I LOVE insurance!

Mum-me said...

How frustrating!

Sounds like health insurance in USA is just as intricately annoying, and health providers are just as lax, as here.

mommeeof9 said...

I never complain about our insurance. 6 yrs ago, someone let my then 3 yr old into the attic. We did not have the floor done their yet and had just finished the insulation, with no drywall in the ceiling below. He decided to jump on the insulation, which he fell through, landing halfway down the stairs and rolling to the bottom. He was medivaced by helicopter to Fairfax women and children's hospital, where he was admitted for 3 days. He had a ruptured liver, a fractured eye socket and both eardrums ruptured. The insurance paid everything, including the helicopter ride ($25,000).

Anonymous said...

I had a tooth extracted by an oral surg. last February. The office staff still has not submitted the claim correctly. I'm not going to pay them if they can't get a bill correct! And it's been a year!
(But I also don't like the games insurance companies play!)

Staci K. said...

Ugh. There is nothing more annoying than being at the mercy of stupid people. lol

Busty LaRue said...

Is your oral surgeon and/or OG related to our cable guy? Seriously! What is up with people being stupid lately?! Glad you got it figured out at least, and rescheduled.

Karen said...

I just went through a similar experience which I'm about to blog about so check my blog later for the full story.

JustRandi said...

Oh My GOsh! We are having a very similar experience with our oral surgeon. And his completely incompetent office manager.

Are you sure you don't live in Denver?

peewee said...

I was getting all anxious and frustrated just READING that! Insurance and doctors are IMPOSSIBLE! I once had to get an x-ray and I had to find provider approved place. SO I called my insurance and THEY sent me to a place...AND THEN I get a full bill and when I call they say..."well, that place is approved but the DOCTOR who took the XRAY is NOT!"
HA!

Maraiya said...

Wow. Now I feel like beating my head against a wall. Again and again and again. This is so frustrating! I can't believe they let this fall through the cracks so badly. I'm glad you were up on it; can you imagine the trouble you would have been in had you just let it go and trusted these people (as you are supposed to do)???

Jo said...

I would be tempted to try another oral surgeon, this one seems to be a bit of an idiot. GRRR. that kind of stuff really gets my dander up!

Jessica G. said...

It's so awesome that you got to use the word "also" legitimately.

tiburon said...

ARGH! WHat a pain in the butt!!

I hate all the hoops they make you jump through