Still Here...Sort Of.

Rumors of this blog's demise have been greatly exaggerated.

I made what I thought was an April Fool's joke funee, and found out some of my readers took it seriously, which wouldn't have been so bad, except I promptly entered one of those phases where blogging became next to impossible, so it really did look like I'd packed up and gone away.  That'll learn me, as my dad used to say, not to joke about serious stuff like blog network hopping.

Anyway, I am still, in theory, blogging at Scientopia.  It's just been the usual life madness.  A picture being worth a thousand words, here's what I've been doing lately.

This morning, the phone rang a little after 9 a.m.  It was the person from my neurologist's office who they've hired to work full time on dealing with insurance companies solely on the issue of getting approval for botox treatment for migraine.  She was calling to tell me that she has left numerous messages for my insurance company's rep and has not gotten a reply, and now it's my turn to try and roust them.  The insurance company has denied my request for coverage, claiming there is insufficient evidence to show that I've failed three alternative treatment options.  The neurologist's office says they've sent them the information.  The insurance company rep says they would be happy to talk with the doctor's office, and the doctor's office rep says they would be happy to talk with the insurance company.  This game has been going on since I got the rejection letter sent out on April 16.  I have until June 16 to get my appeal completed.  I am not optimistic.  I feel like I am swimming in molasses.  I will never reach the shore, and will drown in this sticky morass of everyone saying they are happy to help me if only the other person would do x, and the other person saying they have done x, and would be happy to help me but the other person needs to do y, which is what the first person said they can't do until the second person does x, which their office shows no record of it ever having been done, but if I could call them and ask them to fax x over, and the second person says we faxed mini-x and it's their own fault if it isn't sufficient because they wouldn't let us send more than mini-x and the first person says the second person should know that we need x and the second person says I can't get the first person on the phone and the first person says just ask the second person to call us and...and my head hurts.  It hurts a lot.

Five minutes after I got off the phone with the neurologist's office, my phone rang again.  It was someone from the endocrinologist's office.  They filed a claim with my insurance company for my visit a month ago.  The insurance company has refused to pay until they receive an explanation of benefits form from my Medicare insurance.  I don't have Medicare insurance.  The kind woman on the phone tells me "they are doing this to a lot of people.  You'll have to call and tell them you don't have Medicare, and ask them if they can reprocess the claim or if we have to refile, and then call me back and let me know."

I haven't even had a cup of coffee yet, and I have at least three health insurance phone calls to make.  Plus a form I need to fill out for my in-laws.  Plus the usual paperwork for Z-mom.  I look at the cat curled up on the bed and want to crawl back under the covers and sleep till noon.

A few weeks ago I called the toll-free number Mr. Z's company provides for its employees, for a health advocate service.  The person I first spoke to was very enthusiastic and sure they could sort out the mess and help me get coverage for my botox treatments.  She then transferred me to a nurse who listened for a few minutes and then told me that I should not be calling the health advocates, I needed to file an appeal on my own, and ask my doctor to write a letter for me, and if my appeal failed, then I should come back to the health advocates and maybe they could help me then.  A week later the nice person I first spoke with followed up by email to ask why I had not filled out the paperwork she sent me and I told her about my conversation with the nurse.  Oh no, she said, we can surely help you out!  Who am I supposed to believe, the phone screener, or the nurse who essentially told me to get lost?  What does this health advocate service actually do?

What good does it do for my neurologist to employ someone full time to work with the insurance companies on trying to get approval for botox coverage, if that person doesn't even know anything about the patients on whose behalf she is working?  When I first talked to this person, she didn't know that I'd had a migrainous stroke, and she seemed unaware that my previous insurance company had paid for my botox treatments.  When I tried to explain what I did to get approval from my previous insurance company and offered to help in any way with putting together my file for this insurance company, she was uninterested.  I feel like, I am just a patient, what could I possibly know.

What good does it do for the FDA to approve botox treatment for chronic migraine, if all the insurance companies then just drag their feet and stonewall as much as they possibly can to prevent anyone from actually getting coverage?  It's not like they didn't know this was coming.  I'm sure they all knew well before the FDA decision that it was likely to be approved, and the approval was issued in October last year.  And as of the first of this year, the insurance companies were all still claiming that they hadn't figured out how they were going to cover botox, what kind of coverage they were going to offer.  Seriously?  That's how you run your business?  You wait till the last minute and make it up on the fly?  Pardon me if I don't believe that.  That $1200 I had to pay out of pocket in February is a crime.

And I just can't afford it anymore.  So until the paperwork nightmare gets sorted out, no botox for me.  I just have to deal with the increasing pain and fatigue.  And I just have to hope that I can manage to get it sorted out by June 16.

Or maybe my non-existent Medicare will pay for it.

I guess I'd better stop ranting and get going on those phone calls.  The best health insurance in the WORLD! doesn't work itself out on its own.

17 responses so far

  • Zuska says:

    Right after I posted this, I called the insurance company person, who told me I needed to call the person in the doctor's office - who had called me this morning and told me I needed to call the insurance company person.

    And then my internet went out and I had to reboot everything. For the third time this morning. So I guess I should call Verizon again and yell at them some more, too.

  • Rebecca says:

    I feel for ya, sister. I got the runaround so many times when my husband was disabled and I was doing all his paperwork for him. Doing it on your own behalf has to be 80 million times worse!

    My only suggestion is to maybe contact your state's regulatory agency. I did that after the insurance company denied my husband's appeal for a treatment. The state basically wrote them a letter saying "What the hell do you think you're doing?" and they wrote the state back saying basically, "Oh, we were just kidding! Of course we're approving it! See this letter dated today saying that we approve?"

    Of course, that was not the end of the saga, and they continued to "forget" that they'd approved it, so eventually I had to call in the state again, but I found that every time the state told them to jump, they did it.

    BEST HEALTH INSURANCE IN THE WORLD (for the insurance companies!)

  • DrugMonkey says:

    On the plus side, I think you are gaining ground on the rainy keep shakin' sister!!!!

    • Zuska says:

      UPDATE: Just got off the phone, and at least Aetna now claims to understand that they are my primary and only insurance, and that I do not have Medicare, and that they need to reprocess all those pending claims they have lying around waiting for the Medicare EOB to show up.

      To reward myself for this small victory, I shall go out for a chocolate donut. It's near the bank, anyway, where I have to go deposit a check for Z-mom. In theory that check should be direct deposited, but I need to speak with someone at the company that processes the black lung payments to get that set up, and so far they aren't returning my voice messages.

      After that, it's back to pondering-the-futility-of-life time. Or maybe I'll actually plant something this evening!

  • Rosencreature says:

    I know its not that much, but please know we are pulling for you, Zuska!

  • becca says:

    I swear that my health insurance would be dandy... if they just would believe they were really my health insurance. I have not had another insurance company cover me for over 5 years, yet every semester (like clockwork) they start refusing things until they receive the coordination of benefits form.
    Generally, they can actually accept the "I don't have any other insurance, I promise" thing over the phone. But I have to call them up to tell them all the time (it doesn't help that there have been two times where I have dealt with dual-coverage BY THEM... i.e. Carebear and I both having the same plan, and Offspring being covered by both plans for a time, and then me being covered by both plans for a time... there is no way to indicate "I am covered by two plans, which are identical, and which are both administered BY YOU. Please coordinate benefits amongst yourself" on the form).

    I am pretty much convinced that 'you must have other insurance (or medicare)' is the last refuge of the scoundrel insurance company trying to deny coverage.

    • Zuska says:

      When I called back the nice woman at the endocrinologist's office, she said she must have to call about ten people a week to tell them their claim is being held up because the insurance company is waiting for their non-existent Medicare to pay first. Usually when the patient calls their insurance company and says "hey, I don't have Medicare, you are my only insurance company" they say "oh, right, we'll just reprocess everything". It makes double work for them. But you know, if only one out of those ten people gives up in despair, or doesn't know what to do or how to handle it, that's ten percent of their claims they don't have to pay.

      • Zuska says:

        Well, ten percent of those in the Medicare shell game. There are other games for other people. Like "we deny your coverage for the reason that your coverage has been denied." And "all your paperwork has been lost so you'll have to submit everything again." And "your doctor's office forgot to put a number 2 in the little box on the bottom left hand corner of page two of the claims form right next to where it says 'don't write anything here' so there is no way we can process this claim. They'll have to resubmit everything with the proper codes. No, we can't just write in the 2 ourselves."

        • Super Sally says:

          Reading this makes MY head hurt.

          I've been known to yell at the insurance folks asking for the same documentation already filed that they can't find: "I don't have a staff, so why don't you use your staff to find it".

          It never helps, but it makes me feel better.


  • Sorry you're still going through all this, Zuska 🙁 Know that you are missed, if that helps any.

  • Fuck Z, I'm sorry.

    I'm beginning to think that Kafka was a prophet.

  • snow black says:

    Well, I was really happy to see you had a new post up, until I read it.

    I will be thinking of you with fingers crossed.

  • neurowoman says:

    I'm so sorry to read about your troubles, I feel for you. My mom has actually worked on all three sides of these problems, as a claims processor for insurance companies, as a medical office biller, and as a patient & spouse trying to get claims paid for her own health care!

    The one tip I can give is that you can ask the insurance processor you're talking to (who is a lowly peon) to transfer you to her/his supervisor if they are not giving you satisfactory answers. The claims people on the front line are under enormous pressure to process X number of claims per day and can get fired if they don't, so they don't have a lot of incentive to do it to your satisfaction (although they might actually want to!) Bumping it up to the supervisor means work for the supervisor, who don't like it, and it's more likely to get resolved.

    Also, one of my first thoughts on the run-around is 'conference call'; maybe if you get both parties on the phone at once that would help.

    Again, so sorry, such a screwed up system.

  • Zuska says:

    So, an update: somehow, miraculously, somebody finally talked to somebody, and an approval letter showed up in my mail - I can have four botox treatments over the next twelve months, after which, we'll have to revisit the whole issue, ma'am. Because you might be cured, or suddenly able to take triptan drugs despite your stroke, or who knows what.

    Yay! now all I have to do is schedule an appointment, right? Just call the doc's office and...leave a message. And wait.

    No one calls back.

    Call again. Still no return call.

    Call a third time, get connected to the "botox appointment line" and hear "this mailbox is full. this mailbox is not accepting messages. please hang up and try your call again at a later time." Arrrrrrrrrggggggggghhhhhhh!!!!!!!!!!!!

    Call again another day. ZOMG! A human! yes, you can have an July.

    So, there goes 1.5 months of your 12 month eligibility period. Not to mention being way overdue for tx, and, despite being "approved", not really knowing exactly what "approved" means in terms of how much they'll actually pay.

    But hey! It's progress!

  • [...] In some cases, these policies can indeed minister to a peculiarity of studious care. Research has found that providers don’t always broach caring that follows clinical guidelines; for instance, a 2003 investigate by Elizabeth McGlynn et al examined medical annals from consenting participants in 12 civil areas and found that 11.3% of a participants “received caring that was not endorsed and was potentially harmful.” If your medicine is prescribing a drug or procession that’s not suitable for your condition and has a intensity to mistreat you, it competence not be such a bad thing for someone to be denying coverage for it. Sometimes, of course, an insurer will repudiate something that competence seem inapt to a non-expert with singular information, and a provider will afterwards have to spend time going behind and onward with a insurer to explain because it is, in fact, appropriate. (And removing these things resolved competence take weeks of frustration.) [...]