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Perfectly Imperfect Life..........

Tuesday, October 2, 2012

11 Years In The Making ~

Incompetence runs rampant!!

T was scheduled for a hydroscan at o'dark thirty this morning. We get to the hospital 1 1/2 hrs early as told to and it seems they don't have authorization from the insurance.  
He's hungry and grumbly since NPO since midnight.  No one can call the surgeon's office cuz they don't open until 9am, which is T's actual appointment time......

The hospital lady calls billing and they can't help. I decided to call TriCare to see if they can help. They see no auth ordered but tell me if I have the billing code they can look it up and see if an auth is actually needed. I ask the hospital lady for the code. She then says she has to ask billing.  I hang up from TriCare since the hospital lady says it may take a while.  Hospital lady finally gets a call from billing and gets the code. Hurray!! I call TriCare back and explain to the second rep what is going on and give him the code.........he tells me that code was discontinued in Jan.

Taking a DEEP breath,  I thank him for his time and hang up. I tell the hospital lady that the code is not valid. 
 In that case she says you have to sign this paper that says if your insurance decides not to cover it you will pay.........uh, I don't think so. We all stand there looking at each other, her dumbfounded, me not so much.

They call T back.   We go back, he has his 2 hour hydroscan and we sneak out leave.

     They can do their job and figure out the auth/billing/etc!


Believe it or not this all started 11 years ago. T started having bad pains in his stomach. They did an ultrasound and hydroscan at that time and discovered his Gallbladder was failing, but not enough for removal. He had no stones, so he has been dealing with pain/spasming off and on ever since. A few months ago it got really bad so into our Family Doctor we went. He, of course, sent us to a surgeon. Had a consult with the surgeon and he wanted to do an upper GI first. So we scheduled it. In the mean time I receive a call from another surgeon's office wanting to set up a consult for T. I told them he had already seen the surgeon and a procedure was in place. This office said that that surgeon was not in our network. I was so confused, I made an appointment with the second one. Then started thinking. Why would we need a second surgeon when our insurance always goes in network. I thought maybe our family Doctor wanted a second opinion? I called him and he said no they only requested one surgeon. Now totally confused I called our insurance. They said that the first surgeon, upper GI physician and the second surgeon were not in our network and we would have to pay a percentage of the bills!!  I about had a cow! Why would they authorize out of network Doctors without consulting us!  So I asked for the names of surgeons in our network. She wanted me to get online on their site and find them for myself! HA!!! Been there done that! I told her I have been round and round with their formularies trying to get prescriptions covered and that they do NOT keep their lists up to date. I demanded her to give me names, after all she was right there on the phone with me..uh do YOUR JOB!!   She gave me 3 names of surgeons that were in network. I called our Family Doctor back to inform them of the names and update what was going on. Oh, and we would have to start all over with a new auth since we were changing surgeons. So needless to say it delayed T seeing a new surgeon for another month. I called the two earlier surgeons and Upper GI physician and canceled all appointments. I still can't believe they auth'ed 3 out of network doctors. And would you believe the one he is seeing now is only half the distance as the others!!! 

We got the results from the Hydroscan from the 3rd, and correct, surgeon today and T will be having surgery next Thursday, Oct. 11th.
It is considered out patient surgery so he will only be in the hospital for a day. My daughter has already has had hers out so we kind of know what to expect, even though hers was about 10 years ago.
This Friday we pick up paperwork and auth from surgeons office then head to the hospital for preregistration.
 We should be all set and ready to go....hopefully....

BUT as we all know
Incompetence STILL runs rampant!!

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