Live Blog Update of Insurance ClusterF@#!
Welcome to my day of live blogging where I will bring you the LATEST and GREATEST news on where we are in the process of getting Ana approved by our insurance company…SOMEWHERE…so that she can actually get the giant tumor in her abdomen removed. I will be logging in ALL DAY and THROUGH THE NIGHT if necessary, to keep you informed of the situation. It’s going to be a fun time, folks. Grab some popcorn.
9:45 A.M. – Let the phone calls begin!
Jim tried calling Dr. Wu’s office numerous times and kept getting his service. So he called Dr. Rosencranz and made an appointment for 12 p.m. tomorrow. Unfortunately, since it’s really Dr. Wu (the liver surgeon) we need to speak with, we may need to reschedule his appointment. He was told that the only way to get the doctors to coordinate the meeting time is if they call each other directly. So, here’s our first WTF of the day! WTF? Why do you have 25 coordinators at that hospital if the doctors are they only ones who can coordinate this stuff?
Moving on. My first call of the day was to Delia, a financial coordinator on Columbia’s Liver Transplant team. She was very nice, very calm, very soothing – so naturally I burst into tears after 5 minutes into the call. She is going to follow-up with Finance regarding my questions about Dr. Kato not being in network and will get back to me later today.
I then called CDPHP about the whole “Dr. Kato not being covered in the facility where they tried to transfer Ana” issue. I left a message for my case worker who got back to me and had NO IDEA what to tell me. She said she was referring this to an “out of area” nurse who is much more familiar with this type of case, and then she wondered why it hadn’t been referred to the out of area department in the first place. Hmmm. Good question.
I then spoke with someone at a third party medical billing company about a bill for $3900 I got for Ana’s anesthesia from the first biopsy she had. The E.O.B. (explanation of benefits) I received from CDPHP said we should’ve been billed $2100. This was an excruciatingly frustrating call. The guy kept saying the claim was pending and I’d have to contact my insurance company. I kept saying that I don’t need to contact my insurance company since I had the E.O.B. in front of me and please just bill me the $2100.
“Can’t do that,” he says.
“Still pending,” he says.
“Why’d I get a bill then?” Says I and, without waiting for an answer, “How about this? I don’t pay you until you figure it out.”
I then filed the bill away with a note that I spoke to them and was also delighted with the realization that medical billing is so incredibly screwed up, it may actually work in my favor sometimes.
12:15 P.M. – CDPHP calls me back!
The out of area nurse at CDPHP (Jennifer) called me back and explained that even though Dr. Kato and Columbia are technically out of network, they are considered “in network” because they are a Center of Excellence. OH! OF COURSE!! So I basically spent the weekend obsessing OVER NOTHING. I was on the phone with her for 35 minutes, but I’ll just sum it quickly. CDPHP will pre-approve Ana for transplant at Columbia (well, technically, Morgan Stanley Children’s Hospital at Columbia) with a window of 90 days which includes all pre-transplant services. That includes the pediatric hepatologist I was worried about. Columbia just needs to fax them a letter for pre-authorization, so I’m about to get back on the phone with Delia. It’s looking like we won’t go to Westchester for the transplant since I have no idea if they can figure out how to get this thing approved for us (or how to get us set up with emergency Medicaid) and at this point I can’t wait for them.
1:25 P.M. – Left message for Delia (the finance coordinator at Columbia)
I left a message for Delia to call me back so I can give her the CDPHP rep’s fax number and name. I’m now waiting (patiently) for her to call back.
4:30 PM (ish) – Columbia calls back
Delia from Columbia called me back to let me know that they were still working on getting pre-approval from CDPHP. She called me ON HER OWN. That is, she wasn’t returning my message from earlier in the day, which I believe is a good sign based on the lack of follow through I’ve experienced..um…EVERYWHERE ELSE. So I gave Delia the name and number of Jennifer from CDPHP and she’s going to pass that along to the finance/approval people which I truly believe she will do, and then get back to me towards the end of the week. At this point, it’s looking like Ana will meet with Dr. Kato and other members of the transplant team on Monday. Haven’t heard a thing from Westchester about appealing the transplant denial or getting going with Medicaid, etc. and I don’t really have the strength, time or focus to try to get that going since it looks like Columbia’s way more on the ball.