Still fighting them. Almost seems I am fighting them on two fronts. I call the insurance company (making sure to write down names and dates and times) and find out what they need. I call the referring physician's office and ask for information to be faxed. However, they aren't owed any money in this. I think I may be losing their interest.
Nice as I am trying to be in spite of my frustration. And I admit. I am getting mighty frustrated.
Frustrating Facts of Frustration
Actual statement from benefits summary: 'Pre-authorization is not a guarantee of benefit.' [Now there is a trump card I would like to hold.]
Three 'customer advocates' (also file under Ironic Irony) have told me my procedure 1) required pre-authorization, 2) an initial phone said it didn't, but a 2nd phone call (that a mind reader would have known to make) (my interpretation) would have told us a pre-authorization was needed, 3) a pre-authorization wasn't required.
A 2nd denial (received this week) is based on the fact that the best way to deal with one of 'these' is not an MRI but a biopsy. I call to make sure it is understood we are dealing with nine. 9. NINE! (Incidentally, up from five, found six months before.) Yep. They see that. Biopsies should have been the order of the day.
That according the state insurance commissioners office, to the best of my understanding? They are within their rights. And basically can do whatever they want. And get away with it. (Because why should they fear me?)
Insurance wants family medical history to be faxed from referring physician. Same family medical history that I gave to referring physician. Verbally. But you know. It's more…legit…coming from me, through him, to them….
Those I talk to at the insurance company are called 'customer advocates'. I don't feel like anyone is advocating for anything on my behalf. AT ALL.
Thank the universe and all the powers that be that this procedure proved that nothing was amiss and the nines masses are just hanging out, chatting it up, and playing pinochle, or whatever it is that they do on their off hours. BUT. If something had been all goofy in there…would I be jumping through these hoops, or would that have proved that this was a necessary procedure? Gosh! What a relief to not have to worry about all of this? Just to worry…you know…about having health issues!!!
Resulting in…the feeling that this has 'red-flagged' me with these people. That no further claim with these people will ever go smoothly ever again. And that with that trump card? Why should I ever trust that any claim will ever be paid?
I truly believe it is not just healthcare reform that is required. It is health insurance reform that is required as well.
Because this is just not right.
As I have told my sisters, I feel like a five year old at a grown up's table, learning the rules to Canasta. Except I only have an old half a deck of Old Maid, and the grown ups? They aren't friendly and keep changing the rules and lying to me.