You know you want it

Another insurance update, that is. I aim to please!

I still haven’t heard back from Odalys. Not a peep. Not one to take newslessness lying down, I decided to go ahead and call BCBS one more time. This morning, I spoke to a guy named Justin. Justin was helpful at first, but by the time I had explained that the surgeon’s office needed a letter that included the diagnosis and procedure codes, he was convinced the surgeon’s office was involved in insurance fraud. He just kept repeating “if they want to know what codes to use so that your claim will be paid, that’s insurance fraud!” Dude, chillax. Ain’t nobody tryin’ to defraud no insurance.

Then later in the afternoon, I stumbled upon something online that sparked an AHA! moment. I saw a “request for predetermination of benefits” from a fertility clinic to an insurance company. I thought that perhaps this might be the magic phrase, so I called BCBS again and explained to Stacey that: “my surgeon’s office sent a request for predetermination of benefits on October 10th. I got a letter in the mail saying I was authorized for a hospital stay in relation to the procedure, but my surgeon’s office has not yet received a response to their letter. I’m calling to see if any progress has been made on getting a response to the surgeon’s office.”

Stacy says, “I see that someone named Odalys called on November 20th. She spoke with Mia, and Mia sent all of your information to the medical review team again. Right now, your case is still under medical review, and a letter has not yet been sent to your surgeon’s office. Mia is going to call Odalys as soon as the letter has been generated.”

So yes, this is all still ridiculously confusing. Yes, it’s still maddening that Odalys doesn’t returns calls OR emails OR answer her freaking phone. But I do suddenly understand the difference between what the surgeon’s office has requested (a predetermination of benefits) and the first letter of approval I received (authorization for the hospital stay related to the surgery).

Stacey, the BCBS rep, assured me that I’ve already been approved, it’s just that the medical review team needs to generate the response to the surgeon’s office’s request for a predetermination of benefits.

So yeah, it’s still about as clear as mud, but even this is better than hearing NOTHING.

Cha-Ching!

I did it! I needed a 1300 on the GRE to get the fellowship money for my PhD and I got (drumroll please…) a 1380!

I won’t get official notification about the fellowship until some time in the spring, but it’s a go! What a relief. Seriously, I’m beside myself with the idea that I will be earning this last degree for free. Scratch that. I’m being paid to do it.

I think we catch these glimpses every so often of how God really does have a plan, and this is one of those glimpses for me. Two years ago, I applied to a different PhD program and was rejected. It was a blow and I couldn’t quite understand why I had been turned down. Now, it’s just obvious that there was something better in store for me. Something free!

Scrooge McDuck

All this insurance crap is seriously dampening my holiday cheer. I took today off of work so that I could de-stress somewhat before the big GRE exam tomorrow morning. I took another practice test (scored well!) and then went to meet the nutritionist at 1pm. I piddled around town for a while, did a bit of Christmas shopping, and then met my mom & sister for Rachel’s first fitting in her wedding dress.

Y’all, she looks gorgeous! The dress is very ornate (at least for my taste) with lots of beading and a cathedral train, but it suits her perfectly. I brought my bridesmaid’s dress and had to have it altered pretty significantly even though I ordered it a size too small when I tried them on, so that’s a victory!

Mom, Rach & I finished by having dinner together at Outback and spending time with them was awesome as always. I wonder how much things will change when I can no longer finish up every event with massive portions of food. Guess I’ll just do a lot more talking and a lot less eating!

That is if I ever make it through the insurance bullcrap. The Kurt dude from Healthcare Management Services finally called me back today, and wanted to know which facility my surgery would be taking place in, what the date would be, and if I had adequate support at home during recovery. I explained that I couldn’t answer about the date, that my surgeon’s office is waiting on pre-determination instead of pre-certification blah blah blah. He was completely baffled, and I explained that they needed more than authorization, they needed someone to review my medical documents against my medical policy and then give the go-ahead. He said “that’s exactly what we’ve done. I see you had your psychiatric evaluation with Dr. Marcil. Your 6-month diet with Dr. Richter and Dr. Aung. Alice Baker is your nutritionist. We have already reviewed all of this and you meet the requirements.” OH MY FREAKING GAWD. I knew it.

So I called Odalys at the surgeon’s office. No answer. No answer. No answer. No answer. No answer. The sixth time I called, I was able to speak with her, and I explained what happened. She said, “they can tell you you’re approved all day long, but until we get the letter we can’t schedule your surgery.” I said, “ok, well have you spoken with anyone since last week?” she said, “no, but we were closed two days after Thanksgiving and they’re supposed to give me a call back.” I said, “look, instead of waiting for them to call you, do you think you could call them instead? They’re telling me everything that can be done has already been done.” She grabbed my file and said she’d call them.

Think I heard back from her today with any kind of update? Of course not.

I’m really baffled. When I talk to Odalys, it seems like the insurance folks are idiots. When I talk to the insurance folks, it seems like Odalys is an idiot. Maybe I’m the idiot for not somehow making this all come together more effectively.

So I ask, what would you do in my situation? I’m getting absolutely nowhere! My mother thinks I should email the office manager and let her know what’s going on. I’m hesitant to do that since tattle-tailing isn’t really my style, but it is quite clear that Odalys isn’t a very effective advocate for me.

The only plan I’ve got right now is to give Odalys until Friday around noon to be proactive and call me (for ONCE) before I start getting more demanding with her. I’m tired of having no answers.

Better ideas?

Human Contact Established

Discouraged after reaching Kurt’s voicemail for the 98th time today, I called Healthcare Management Services and spoke to an operator. She said I’ve been approved as of November 21st, and that we’ll be getting a letter in the mail. I asked if she could fax it, the answer was that the surgeon’s office has to call and request the fax. (more run-around, I know).

So I left a message for Odalys at the surgeon’s office to know that the guy Kurt called me, I wasn’t able to get in touch with him, and that I spoke with a representative who said I was approved. We shall see what happens next….

Do you notice how I’m not excited? How I’m not thrilled to be approved? Yeah, I’ve just been through this all a few too many times now!

The latest

Thanksgiving: awesome. I have the best family imaginable, although it’s getting more difficult to fit everybody in one house. I can see that we’re on the verge of branching out into our own little mini-families now that so many of us cousins have had children of our own (excluding Lee & I–we’re the barren ones of the bunch). I’m cherishing these times where we’re all together.

GRE: Thursday. Lots of fellowship money is riding on this test, so I’m in “the zone” trying to prepare. Despite the fear, I know this will all turn out well. God is not a tease.

Insurance approval: nothing new. Some dude named Kurt from Health Management Services called my home number yesterday and left a message. I’ve called him back approximately 87 times today, only to get his voicemail. I’ve left 1 message, so all I can do is wait for him to call me.

Question: when a doctor’s office tries to reach me, why do they always go for the home phone number? With nearly all men and well more than half of all women in the work force, why in the world to people assume anyone would be home to pick up the telephone at noon on a Monday? I’m going to stop giving away my home number and use my cell exclusively. We only have a home phone so that our alarm system can call the police if need be. Other than that, it’s totally useless since we’re never there during business hours.

Weight: not good. I’ve been battling in the low 300’s for over two months now. I’ve gone from 307 before Thanksgiving back up to 310, and I’ve been counting calories and tracking my foods on FitDay. I don’t know why I’ve stopped losing suddenly. I suppose it could be attributed to stress. I’m just going to keep sticking to the plan, keep getting enough sleep, etc and I know I’ll keeping dropping pounds. I had hoped to be down under 300 by now, but I’m in no mood to starve myself to try to get there. It will happen.

Husband: hasn’t been back to the counselor. It’s a busy time for both of us, so I’m not pressing. He has a job interview Friday morning which is somewhat unexpected. I don’t think he’ll end up taking it, but I hope they offer it to him anyway. He could use the boost of self-esteem and the illusion that he’s not stuck in his current job.

Insurance fun

Odalys called me back after an email that made it pretty clear I was frustrated with all of this insurance nonsense.

She got on the phone with BCBS, got more of the same run-around, and found out that the person who originally handled my claim first reviewed it as outpatient, then moved it to pre-certification instead of pre-determination. So all this time, the pre-determination department has NOT been reviewing my case. I am NOT approved. I just wonder why Odalys didn’t figure this out when I told her I was approved LAST Tuesday??

Odalys had the lady Nina at BCBS expedite my pre-determination case since it has been lying dormant since October 10th (which doesn’t make sense. I hadn’t even finished my 6 months until October 22nd. Whatever).  Then Nina is supposed to call Odalys back to let her know what to do next, and then Odalys will call me and let me know what’s happening and if I don’t hear from her tomorrow, have a happy thanksgiving.

I’m so over it. Obviously, I’ve given up on the idea of a December surgery. And the doctor will be out of town for the majority of January, so hell, I could be looking at flippin’ February. All I can do is wait.

Oh, and I guess I need to start hoping I’m approved too (again…).

done.

I can’t try to  make this insurance thing go any faster. I can’t keep trying to reach the pre-determination coordinator because she never answers her freaking phone. I can’t keep running around in circles trying to get this done.

In the last 24 hours:

  • My surgeon’s office said the approval letter faxed them isn’t specific enough: it should have a procedure code, diagnosis code, and hospital facility listed
  • one BCBS employee told me the surgeon’s office is giving me the run-around and that they couldn’t possibly need anything else than what the letter already states
  • another BCBS employee said he could get the information they need faxed to them lickety split, no problem, but that a hospital facility will not be listed since the information from the SURGEON’S OFFICE did not list a facility (and than any in-network facility would be fine)
  • the surgeon’s office said that Odalys is in meetings with prospective patients all day and that the fax never arrived (5 hours after the “I’ll fax that right away” phone call)
  • BCBS said there IS no letter with additional information, and that I should have my surgeon’s office call them directly

Um, yeah, that would be great, but they’re  obvious not on the ball. I am literally sitting here at my desk at work, door closed, blogging to the stop the crying because I’m so dang frustrated.

I have been meticulous about documentation since day 1. I was approved on November 8th. I’m just going to try and put this out of my mind, because I’m obviously getting nowhere any time soon.