Insurance Companies - AAAAARRRRRRGGGGGHHHHH

OK, so I have spent the morning on the phone with just about everyone.

My first call was to the medical group that handles getting authorization for all my procedures.  The rep said, "Oh, we don't handle that insurance company any longer. You have to call your former employer to find out who does."

So, I called the human resources group of my former employer.  The rep there says, "Is that right?  Oh no.  I have the same insurance, so let me know what you find out!"  Huh?  Totally useless.

So, the next call is to the actual insurance carrier, Blue Shield.  The rep there says, "No.  The company you called first still handles your authorizations."  So, apparently, the original rep didn't have a clue what she was talking about of didn't look at my records.  From what I can gather, my former employer discontinued having BlueShield as a provider for MediCare patients.  I'm not quite at MediCare age  yet, so I was able to continue with Blue Shield.

So, I contact my urologist at Stanford and give them all the information.  The nurse there sends all of that over to the group handling authorizations.  I just got off the phone with them and their records indicate that they called the original medical group (that I had made my first call of the day to) and was told that since this is an emergency authorization, it will "only" take them up to 72 hours to determine eligibility.  I was told to call back at this time on Wednesday.

So, I'm pretty sure that I'll not be getting the CT scan in time to see the urologic oncologist next Tuesday.  I'm guessing that to reschedule that appointment will take me into March or so.

I guess one of the benefits of MediCare is that none of this would be needed.  My wife will be tranitioning into MediCare in March and with the plan she got (a MediCare supplement), she can go anywhere that accepts MediCare and not worry about a referral.

The only saving grace of this entire fiasco is that I am 99.99% certain that my CT scan will show that everything is fine after the surgery and, with a clean chest x-ray, it's not exactly like I have to get in to see the urologist or the surgeon any time soon.  But my goodness, this has certainly been no fun at all.

donna_lee said:

Ins co's are SLLLLLLLLLLLooooooooooooow

From the time of scheduling, they had 3 months to review everything.  The Hospital may have received the OK, but I didn't receive a written letter of approval until 3 days after the test.

From now on, I will call the ins. co to notify them once the test is scheduled, to "ensure" that they don't drop the ball.

And if we don't have enough stress knowing we've had cancer, the insurance companies, and their pre-authorization companies can give you a big case of "The Mads.".

Hope that when you do get the CT, all is well.

donna_lee

Got the authorization!  Stanford just called me with the good news.  Since my appointment had been for this morning, I had to call Radiology at Stanford to get a new slot.  My appointment with the surgeon who performed the partial neph is on Tuesday, so I wasn't certain if I would have to reschedule that or not.  They got me an appointment at 9AM tomorrow morning in a satellite facility they operate that is even more convenient than the hospital on campus.  I've been there before.  I can't say enough about the customer service at Stanford.  They are absolutely top notch.

rwmiller56 said:

Glad you got it worked out

BAG,

Glad to hear that you had success in the end. I to am using Stanford. Most of my care is out of the satellite office in the South Bay. They have been nothing but excellent in both care and patient service.

A day before I was due to start radiation therapy for my bone met, my insurance company denied my radiation treatment as "not medically necessary". Yes, that's right. I was infuriated, and felt insulted, but Stanford went to bat for me and had the decision reversed in less than a day.

Wishing you the best outcome on your CT scan.

Roger

I got my scan at their Redwood City satellite.  Could not have been easier, except, of course, for traffic on 101 in a rainstorm.  I go see the surgeon on Tuesday morning on the main campus.  I'm not expecting anything but good news.

I have to agree with you about the quality of care from start to finish at Stanford.  I've had a couple of unrelated intestinal surgeries at another hospital further up the Peninsula, and the care was good.  But it doesn't compare with the A to Z care that Stnford gives you.