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Insurance Companies - AAAAARRRRRRGGGGGHHHHH

Bay Area Guy's picture
Bay Area Guy
Posts: 495
Joined: Jun 2016

So, on another thread I mentioned that I was going to have my first follow-up CT scan nice and early on Monday morning.  Well, not so fast bucko.  I got a call from Stanford at about 5PM today (Saturday), less than 48 hours before the CT scan, saying that unless I was willing to sign a document taking responsibility for the cost of the CT scan ($7,000+), they couldn't give me the scan because my insurance company still hasn't approved (or denied) the request for the scan.  Well, I'm not exactly in a position to cover $7,000 for a CT scan, so they canceled it.  Now, I have to call the insurance company on Monday and HOPE that they can approve the request so I can reschedule the scan for some other time next week (fat chance) because I have a follow-up appointment with the surgeon and the urologist on Tuesday the 17th.  I'm guessing I'll have to reschedule that, which likely means, given the surgeon's schedule, I should get a follow-up appointment in, oh April sometime.

Sheesh.  Insurance companies drive me crazy.....and I don't even know what they'll cover for mental health care when I snap!!!

Footstomper's picture
Footstomper
Posts: 1238
Joined: Dec 2014

I had a similar problem a couple of years back. I told my Oncologist and he had it sorted out within a day or two. I think its ugly, repellant, but so common the docs know how to deal with it.

Bay Area Guy's picture
Bay Area Guy
Posts: 495
Joined: Jun 2016

Just sent a note to my doc about it.  I'll have to reschedule the CT, but hopefully they have an opening next week so I don't have to reschedule the doc.

Jan4you's picture
Jan4you
Posts: 1327
Joined: Oct 2013

Geez, so sorry that happened. No wonder you are so frustrated!

But your surgeon or whoever ordered this scan needs to make a case for it. I remember my insurance 1x denied an inpatient stay from ER and before I could even fuss at them, they paid for it! Sometimes its computer programs spitting out these denials. Need to talk to a HUMAN and let your MD know first.

Let us know what happens, as we identify with this issue!

Hugs, Jan

JerzyGrrl's picture
JerzyGrrl
Posts: 760
Joined: Jun 2016

It could also just be that -- due to the holidays -- this office forgot to process the OK and / or neglected to tell that office that it's OK.  Unfortunately, I can identify with that, too. 

mrou50
Posts: 389
Joined: Mar 2013

I get tired of the battles with insurance companies.  By far for me anyway, the most frustrating part of cancer.

Mark

JerzyGrrl's picture
JerzyGrrl
Posts: 760
Joined: Jun 2016

I've had some similar issues.  In my case (since I have an HMO), it generally involves the insurance company, the health group, the surgeon's office, me, and occasionally I get my primary physician involved just for fun.  When you call them, be polite but firm and use phrases like "delay in treatment," "what might I do to assist you in resolving this," "your name again is," and "so what you'll be doing to expedite this is...." Take notes, be willing to go up the food chain, be optimistic, be calm.  But you probably knew all this already, right?

Laughing

Jerzy (who'll be thinking of you being polite yet firm tomorrow morning)

Bay Area Guy's picture
Bay Area Guy
Posts: 495
Joined: Jun 2016

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's picture
donna_lee
Posts: 999
Joined: Feb 2009

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

Bay Area Guy's picture
Bay Area Guy
Posts: 495
Joined: Jun 2016

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.

JerzyGrrl's picture
JerzyGrrl
Posts: 760
Joined: Jun 2016

Hey, Guy -- That is SUPER!

My "Plan B" when I've been up to my eyeballs with authorizations has been to let one of the offices know that I'm releasing the authorization mess into their hands because they are the professionals.  Sounds as though Stanford came through, and then some!! 

Jan4you's picture
Jan4you
Posts: 1327
Joined: Oct 2013

GREAT!!! Sorry for the hassle.. now on to GOOD NEWS!!

Hugs, Jan

rwmiller56's picture
rwmiller56
Posts: 40
Joined: Nov 2016

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

Bay Area Guy's picture
Bay Area Guy
Posts: 495
Joined: Jun 2016

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. 

Shecka1121
Posts: 114
Joined: Apr 2015

hi there,  The same thing just happened to me bay area guy.  I am stage 1 also and they approved CT of chest but not the mri of the rest of the body. i have to start the calls now.  Any tips?

daisybud's picture
daisybud
Posts: 506
Joined: Jan 2016

They wouldn't approve mri for me either.  Called now getting ct scans Wednesday  because they don't need authorization.  I Wanted mri because it has no radiation but now getting ct scans chest to pelvis.  Funny thing is hospital is charging twice as much for ct as for the mri.  So Insurance has to pay out more money! Don't get the insurance companies at all!,

 

daisybud's picture
daisybud
Posts: 506
Joined: Jan 2016

Also I was told by Dr office that mri are harder to get approval for than ct.

Footstomper's picture
Footstomper
Posts: 1238
Joined: Dec 2014

If it was your Dr (or Onc) then they should be ble to sort it out with a phone call. It would be a brave insurance clerk (they Dont exist) who would be willing to pit their wills against a Doctor in such a matter.

Bay Area Guy's picture
Bay Area Guy
Posts: 495
Joined: Jun 2016

I called everyone I could.  I started with the medical group that handles the processing of referrals on behalf of the insurance company.  They're local, but they proved to be less than worthless, if that's even possible.  So I got at them from both directions.  I called the insurance company to complain and they, in turn called the medical group to tear them a new orifice.  I also called Stanford, where I got the treatment and where I'm getting the followup.  Their people did a frontal assault on the medical group.  Within about six hours, I got a call from Stanford asking me to schedule the CT because the medical group gave them the authorization.

I'm sorry to say, but you have to pretty much be an a-hole with the insurance companies and their minions because their basic job isn't health care, it's cost avoidance.

daisybud's picture
daisybud
Posts: 506
Joined: Jan 2016

Dr urologist/surgeon wanted mri and chest xray and he said would go to both him and onoc. They're both using same scans.  After it was denied he changed it to one ct of kidney without contrast.  Called onoc and they are doing cts with and without.  My kidney labs are good . Just annoying i am  only going with the onoc for decisions on scans from now on.  Hopefully easier. 

Kim

Footstomper's picture
Footstomper
Posts: 1238
Joined: Dec 2014

1/ Are you (insert name here) more qualified than my oncologist in making this judgement?

2/ is whoever is making this judgment rated among the top 50 oncologists in the country?

3/ can we please follow the expert advice of my oncologist?

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