Friday, April 16, 2010

Frustration with Corporate Entities

I have had a lot of frustration this week. Frustration is difficult because the difficulties stem from many levels.

This week, my frustration was with bureaucracy that makes no sense.

Last December I needed to see an out-of-network medical provider. I called my insurance company and got the required pre-authorization to go see the specialist. I got the billing info, the provider's special codes, the whole nine yards. I received my pre-authorization letter in the mail. Then I made an appointment and went to see my provider. In the middle of my pre-authorization, I get a letter that my husband's medical benefits are changing after the first of the year. So, after the first of the year I would need to receive new pre-authorization (i.e. do it all over again) to continue seeing any out-of-network providers. I call up the new 1-800 number because I had two visits scheduled for after the first of the year, and they tell me "no problems."

I get a summary two weeks ago from the insurance company denying my claim for the first two visits I had in 2009... because I didn't get preauthorization.

I figured, "Oooh, it's a mess up, because thanks to my wonderful filing system, HERE is my preauthorization letter."

Alas, it can't be that easy. Apparently, the Mega Clinic I went to see my specialist bill the charges under some other provider's name... a provider I didn't see.

Okay, well, I'll call the Clinic and have them fix it. Alas, the Mega Clinc has some rule about billing under the name of the supervising doctor (whose name I didn't have preauthorization for) rather than the mid-level doctor, and, of course, I saw the mid-level. What can I do?

"Call your insurance company and tell them it's our policy NOT to bill under a mid-level's name, which they should know, and that we're happy to send them a letter from your provider, IF YOU WAIVE YOUR RIGHT TO PRIVACY, to send them the information they're seeking.

So, I call the insurance company who responds with, "You'll need to call your provider and have them give you an itemized bill with your provider's name and the charges on it. Fax it to us, we'll pay what's covered and then you can pay them."

I call the Mega Clinic back (and may I say that the woman who was helping me was very nice. I do not blame her for the large corporate bullshit at all). The woman at the clinic explains to me that it's not just a clinic policy to bill under the supervising professional -- it's a state law. Well, crap. She tells me she's sorry that I'm having to do unnecessary footwork. And what she would suggest I do was to come in and sign off the permission so they can share my info with the insurance company and then give the claims department at the insurance company the name/number and fax number of the poor person at Mega Clinic that spends every day in the red tape and let them duke it out. Because, I, as the patient, met my paperwork requirement when I got pre-authorized.

So yesterday, I went in and signed the paperwork to sign away my privacy, so Evil Insurance and Mega Clinic could get together like two long-time divorced parents who still hate each other while their only child is not in the room.

Then I called the insurance agency and said, "Here's the name and phone number to call and here's the fax machine number."

Because right now I'm sitting on $500 in medical bills to Mega Clinic. And well over half of it should be covered by Evil Insurance, and that's just the first two appointments. I can't wait to see what happens with the second two that were after the first of the year...

Grrrrrrrrrrrrrrrrrrrrrrrrrrr. It's no wonder I run. Or I'd punch someone in the face.

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