Wednesday, January 7, 2009

Post 9 - Insurance Approval Tag

12/24/09 -- Yep Christmas Eve.

Receive a call from the local health system provider (mine), informing me that they haven't received authorization for my chemo yet. I inform them I'll be calling the insurance company immediately. The office close at 3pm today, so they'd need authorization by then.

Hang, and call the insurance company. I'm informed that I am 100% covered for the sessions, only they haven't received a request from the oncologist's office yet. Oh really... OK.

I hang up and call my oncologists office (remember for the PET Scan I told you not to blame the insurance company yet). You see the call that started this all came from some central patient relationship center, and not the doctor's office itself. I'm informed they can't find my file, but will call back in 5 minutes when they locate it.

They call back as promised, and inform me the file hasn't made it to the billing department yet, so no request has been made. I ask if they can process it in a little over 2 hours. Shouldn't be a problem.

You see where this is headed? I'll skip ahead some calls.

14:30 (2:30pm) -- no authorization yet, but Tina informs me she's expecting it any minute now.
14:40pm -- nope, not yet.
14:45pm -- "You have reached Cancer Care... Our offices are closed at this time for the holidays." Are you $%(#@} kidding me?!?! I decide that if I don't hear from Tina by 14:50, I'm paging the on-call doctor.
14:50 -- Tina calls, as I'm about to pick up the phone again. Still nothing. I ask what happens at 3pm? I'm told I can sign a waiver and pay if the insurance company refuses treatment (sound familiar). Now, I was told by the lady at the insurance company I spoke with earlier that I'm covered, but what if some paperwork mix-up occurs, and they refuse treatment because it wasn't pre-authorized... I'd be screwed.

I inform Tina that this is not an option, and ask who'll be staying after 3pm to wait for the call from the insurance company. You see it's not really their (insurance company's) fault, as if I wouldn't have called at 12:50 to point out the fact you (oncologist's office) never made the request to the insurance company, I wouldn't even be this far along.

(crickets... absolute silence...)

"Uh... well, yeah... we wouldn't have even requested authorization today, but the office closes at 3pm, and we all go home."
"Not the right answer. I'll stay on this line, while you use another phone to call them right now, and see what's up."

15:02 - Houston, we have authorization. Thank you Tina, and have a Merry Christmas!

No comments: