After participating in NaBloPoMo for the last 3 (?) years, I'm skipping it (aside from reading/commenting when I can on other blogs). Seeing as I've recently scaled back to blogging once a week, I know that posting daily is not a challenge I can tackle while focused on life's other 'stuff'. I look forward to reading as many posts as I can, and checking out some new-to-me blogs. Unsure what NaBloPoMo is? Here's a link.
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| rooftop bar. Such a cool place. See the giant fire pit in the center? |
Friday night we visited a rooftop bar. When we scooted past tables of people to check out the view, I overheard a person: "Wait, does the insurance company have a doctor on staff? Like how can they decide that?"
I didn't intend to eavesdrop, but I wanted to pull up a chair and join the chat. I'm more convinced than ever that this is a hot topic, so here's a few of my experiences.
Denied: Rae's EMDR claims: Remember in the winter - Rae started doing EMDR therapy? We'd chosen the provider because she was in network with Blue Cross Blue Shield. All claims were denied. We thought we had it figured out. Then the provider took a leave of absense for several months.
In June she started again, more denials. I called Coach's company. I called BCBS often and was asigned a person.
Finally, I got through to someone else. She figured out that the provider had changed offices, but hadn't updated her address. She needed to get her credentials in order.
I almost wept. I told the woman I'd lost track of the hours I'd spent. She sighed, and admitted "I can see it on my screen. You've called here a ton."
In good news, Rae is back doing sessions. We paid out of pocket in the summer, so she could continue. That money is now being applied to the copays - but in August the provider halted treatment until all claims were paid.
All along it was the provider who'd dropped the ball. I think she should've given us a few free sessions. Totally aggravating.
90 day supply: I'm out of one of my 'OG' meds. Last month, I got a letter from BCBS telling me that I needed to mail order a 90 day supply. I called BCBS to ask them how, where? We got off topic, because my doc had called in a replacement 'Preferred' med. BCBS refused to pay for Preferred.
I never got the info about how or where to order the 90 day supply of OG. In the confusion over 'Why can't I get Preferred - since my doc wants me to take it?' discussion, the doc re-ordered OG (she'd cancelled it when she ordered Preferred soon-to-be-denied med) and since I was able to get OG filled for 30 days at my pharmacy, the 90 day supply mail order thing fell off my radar.
Now I'm out of OG and the Preferred med still hasn't been approved for me.
Denying the new suggested med: So, without getting too graphic, because some things are best not discussed in polite company . . . the OR and the Preferred are for my IBS. The side effects are, er, unpleasant. I believe Preferred comes in different stregnths, so the doc can manage side effects by putting me on a lower dose, if need be.
At the end of the day, if my doc says I WANT HER TO TAKE PREFERRED. Then I feel pretty strongly that BCBS shouldn't be saying SHE NEEDS TO TAKE THREE OTHER OPTIONS FIRST, then names the other options.
Hey, BCBS - you're not the doc. Do the insuring bit and shut it.
Coach's perspective: Coach shared an example with me. As a PT, he says sometimes insurance will say WE WON'T TRY THAT UNTIL THE PATIENT FIRST TRIES A CORTIZONE SHOT. This gets Coach fired up, because CORTIZONE CAN DAMAGE HEALTHY TISSUE.
APPEALS & REHAB: My dad came home from rehab Friday, where he's been since he broke his hip. A few weeks ago, insurance tried to send him home. We appealed won an additional week. This past week, same scenario, except our appeal was denied. He will still get PT at his house, but he was making great progress there. We have round the clock caregivers, but when I was at his house Friday, he was already insisting that he get to go into his study.
I finally took a video of his piles. He wanted a specific stamp collection book. Yes, he's 86, why do you ask? He identified it in the video and I brought it to him. So much easier. I fear that he thinks he can do too much, or that he'll order his caregivers to let him do too much.
*****
I feel like insurance dictating how many other meds a patient tries first is a new thing? Am I wrong? Anyone else experiencing this nonsense? Have you overheard anything interesting at the next table at a restaurant lately?




























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