FRUSTRATION

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I saw the optometrist at my ophthalmologist’s office for a refraction on 8/13.  I was told this appointment was for “measurements” for the Intacs surgery and the fee was $79.00, so when I just got a refraction, which I had done 3 days prior with my personal optometrist to get the trial contact lenses, I was rather irritated.

An assistant did the whole refraction—not the optometrist—and he only came in for a minute at the end to review the notes.  He informed me that from there I needed to make another appointment with a different optometrist at the clinic to get these measurements I need for surgery.  I expressed my frustration about being given the wrong information by my doctor, but there was nothing to be done.

I went to the front desk to schedule the next appointment and to make sure they were aware that I had brought a copy of the records from my optometrist from the previous Friday, showing that I had “failed” the contacts as required by my insurance’s prior authorization process.  The woman at the front desk had no idea what I was talking about and said she’d never heard of insurance covering Intacs, but that she “works on the medical side of the clinic, not the surgical.”  I told her I had e-mailed the surgical coordinator with the information, but had never heard back from him.  Who was dealing with my much needed prior authorization?

Apparently no one.  I started to get really frustrated, as it had been one week since I saw my ophthalmologist and was told that I needed Intacs because he wasn’t confident that the cornea in my right eye would “hold” for 45 days, which is the waiting period for the CXL clinical trial. Someone should have called my insurance that day and all they would be waiting on would be the proof that I “failed” contact lenses.  I had another appointment scheduled two days later for an unrelated ocular disorder, and just left with hopes that things would be rectified by that time, as the woman at the front desk said she would give my information to the prior authorizations person.

Fast forward to 8/15 (2 days later) and I ran into the surgical coordinator while I was waiting to be seen by another ophthalmologist there.  He gave me some excuse as to why he hadn’t read my e-mail and reiterated what the woman at the front desk had said earlier this week regarding insurance not covering Intacs.  This was a complete contradiction to what my doctor had told me, and he was in the office that day, but has at least a 2 hour wait and you need an appointment to talk to him.  How irritating.  I asked what the cost of the surgery was—again, one eye only—and about died. There was no way I could pay for it without insurance, especially since I need to pay $2,500 for the CXL on my other eye if I get into the clinical trial.

I was really upset at that point, as the front desk wanted to schedule me for the measurement appointment, which would cost $250.  I reiterated again that I was told this would be covered by my insurance and asked what the prior authorization person had said.  She didn’t really answer my question, except to say that it’s usually 90 days to get approval from an insurance company and my eye can’t wait. I was so frustrated and said I wouldn’t have even paid for the contacts if I had known all of this.  Why had my doctor told me a different story?  The surgical coordinator’s advice was to call the insurance company myself, which I already had and was told they needed a code.  I don’t understand why this is my job.

I went home and called my insurance.  I lucked out and got a very competent and capable woman on the other end of the line.  She thought everything they told me was very strange, especially since without the Intacs my insurance will be paying for a corneal transplant in due time.  She got all of my information, as well as my doctor’s, and said she would research coverage on Intacs, contact her prior authorization department, and call me back the next day.

That was today.  Well, did I get lucky.  First of all, no one from my doctor’s office has even contacted my insurance company per her notes, so how could they tell me all that false information?  My insurance representative told me that Intacs for keratoconus were covered as long as I met the criteria, which wasn’t much, and the only thing I didn’t have on 8/6 was the “failed” contacts part.  I asked if she could e-mail me the document and fax it to my doctor’s office, which she did.  I asked her what the review time was, as I really doubt it takes 90 days.  It’s 7-10 business days or less than 48 hours if marked “urgent.”  I asked her to note that on the cover page in the fax. I thanked her a million times over for all her great research and follow-through, as that’s how I function in the world myself.

Now, since I thought a corneal transplant would be my only option yesterday, I made an appointment for tomorrow with my doctor to discuss Plan B out of utter desperation.  Let me say again that I was at the clinic on Monday, Wednesday, and might still be there Friday.  Ridiculous.  I didn’t get off the phone with my new friend at the insurance company until after 5 pm, so even though the office staff and doctors are still there, the phones go to the answering service.  I had them leave word with the woman at the front desk that a fax was coming and to please call me, as I needed to cancel the appointment with my doctor tomorrow since it was no longer needed.  She never called me, of course.

I also e-mailed a rather stern message to the surgical coordinator and attached the insurance document with instructions to “please get this into the right hands and expedite it ASAP.”  Now I will have to call in the morning and hope they don’t charge me for cancelling the appointment I never needed, thanks to them.  They get paid to do this job and it’s stressful enough to be losing your sight, especially without a true cure out there.

Sometimes I just want to give up due to peoples’ complacency, but I know I have to keep pushing forward and not let anyone get in my way.  I was never the type who needed to be everyone’s friend, and in this situation, my assertive personality (“the squeaky wheel”) has benefited me again, so long as my doctor’s office now sends the information my insurance company needs to get this procedure covered.

Feeling rather disgusted by nearly everyone tonight.

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2 thoughts on “FRUSTRATION

  1. redclift36 says:

    I could have written this on 11/20/2015 except I was on the phone with my insurance comp for 55min. I will follow up with the coordinator on Monday. She only gave them the two procedure codes and no Diagnostic codes and then called me to tell me it was denied. Just do your job please.

    • Hi Redclift36,

      Thanks for dropping by. I feel your pain and am so fed up with the American healthcare system! We have to be the doctor, the coordinator, the MA, the biller and so forth when we are the PATIENT with too much on our plate already. I ended up not needing Intacs as I paid for CXL surgery via an FDA clinical trial in both eyes out-of-state which has stabilized my vision for 3+ years, but before that the doctor I wrote about refused to believe that my insurance would cover Intacs and I had the documents, codes, etc. to prove they would. I think he just wanted the cash in all honesty as corneal surgeons perform a lot of cash surgeries, like LASIK. Scary…

      Best of luck to you!
      A 🙂

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