If I die waiting for this surgery, sue someone!

I’ve been MIA this week, only because as soon as the GRE was done (woot! fellowship! yeehaw!) I had to go right into finals mode. I had about 6 weeks of coursework that had piled up while I focused on practicing the GRE, so I had NO time to get everything done by various due dates. And my husband was off of work this week, so there was absolutely zero chance of getting any work done at home. So that meant late-nights at the office, followed by a 2am wake up call to get back up and do it all again. Seriously, this was the most sleep-deprived week of my life. But I made all the deadlines and took Thursday off to catch up on sleep and to let my mind relax a little.

When I went back to work on Friday, I started working on this whole insurance issue again. It went a little something like this:

  • I called BCBS and spoke to a customer service person. I asked, “my case has been under medical review (again) since November 20th? Is there any news?” and the person said that my case was no longer under review as of December 6th, that the reviewer said “this has already been approved.” I asked if a letter would be sent that answered my surgeon’s request for predetermination of benefits, and the girl said “we don’t ever do that. You’re already approved.”
  • So I called the surgeon’s office. Odalys was gone for the day, but I spoke to the woman who sits across from her. I basically said, “what the crap do I have to do to get a surgery date? I’ve been approved, and insurance is NOT going to send the letter you want. They don’t do predetermination of benefits.” She said that sometimes people have to fight with their insurance to get the letter. And I very nicely asked, “so what is Odalys’ role in this? Does she pursue the letter or is that something I’m supposed to figure out on my own? Because I have very hard time getting ahold of her.” The woman answered, “Odalys is very good at what she does, and it seems like she’s unreachable because she’s always on the phone with insurance. I know she has been working on your case, but she literally has thousands of patients. Sometimes it takes a while to get the letter we need.”
  • So I called BCBS again, talked to another customer service person, and said, “look, I need this letter. I cannot have surgery without it.” The guy said, “we don’t normally do this, but let me transfer you to Health Management Services.” I talked to a chick there who basically put me off time after time, but I said, “look, I don’t need another computer-generated letter. I need someone to sit down, review my case with my policy, and answer the request for predetermination of benefits from my surgeon” she said, “we never got a letter from your surgeon.” “yes you did, it’s dated October 10th and you received it October 15th.” “well we need to talk to your surgeon’s office since they’re requesting this. Have them call us back in the pre-certification department because they’ve been calling the wrong people.” I said, “look, I’m on the phone with you now, I’m requesting this letter. Let’s figure out who it needs to go to right now.” she said, “well we need to know exactly what they’re looking for.” I said, (for the third time), “they need a letter stating that you’ve reviewed my case, that I meet the criteria for the surgery to be considered medically necessary, and that it’s covered under my policy.” Finally after thirty minutes of getting nowhere, the girl put me on hold and talked to her supervisor. The supervisor took Odalys’ info, and she’s supposed to call Odalys on Monday.

I swear, this whole experience may very well kill me. I’m not going to have a letter before Christmas. I won’t have the peace of mind of a surgery date for several more weeks. This is such a freaking annoyance.

But it will happen.

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One Response

  1. It will happen and congrats on you getting tougher with them! I still think if no answer on Monday, it is time for you to demand a supervisor at the insurance company. My husband would say that when you call, you immediately ask the rep the name of his/her supe. Then explain your situation to the rep. If they cannot help, you request the supe by name and when you get that person, you immediately ask for the name of their supervisor, and repeat explaining your situation. This way when you reach the top, you are armed with names of people who are supposed to be able to assist you! Hang tough, girl!

    Glad your week from hell is over! I missed you! 🙂

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