Monday, September 21, 2009

SUPREME Frustration

So, after still not getting a call back from Memorial Health System's biller, I called TriWest again to see what I could see. This time, I spoke to a representative who explained things thoroughly to me. You see, what prompted me to call again was the fact that I double-checked that I doctor I had seen was a contracted care provider (she was). So I explained that I wasn't really in violation of my authorization paperwork. This rep explained that the reason I was being charged a co-pay was because even though the two doctors work in the same practice and both are contracted providers, I was authorized to see a multi-specialty doctor and the doctor I actually saw was an OB. (Smack forehead here.)

She said that she agreed with me that it should be covered, so she gave me all the information I needed to write an appeal. That's right, she said that I could appeal it - not that Memorial would have to appeal it. I explained that the last rep had said that I didn't have the right to appeal, which she said was wrong because I was being charged money - ergo, I have the right to appeal! Hallelujah! She gave me the claim number, explained what I should say in my letter, gave me the address, everything. She also said that she would look back to see who I had spoken to previously and make sure that the rep understood what she had done incorrectly and see how she could have better advised me from the start, instead of misinforming me and leading me on a wild goose chase.

Conclusion: there are still good people (like my mom) who work in insurance who aren't trying to screw good people over. And sometimes, you need to keep calling people until you find someone who can give you a valid response.

But that's not all folks. No siree. Last Friday, I was supposed to have a periconsult for transfer of care appointment with the perinatalogist at Maternal Fetal Medicine. Thursday, I received a phone call saying that, due to an emergency, my appointment had to be canceled and rescheduled. As a result, my OB appointment (which was supposed to be this Wednesday), would also need to be cancelled and rescheduled. She said that they would need to confer with the doctors and see when I could be seen, so she couldn't reschedule me at that time. Well, Friday came and went with no phone call. So I called this morning to get the appointment rescheduled myself. Now I have to wait ANOTHER MONTH to see a doctor!!! The last time I saw a doctor who examined me was FIVE WEEKS AGO! I was supposed to be on a bi-weekly appointment schedule already, but instead, it's been over a month since I've seen a doctor who has taken the time to examine me, rather than just a doctor who looks over the ultrasound images to make sure that everything is progressing as it should. So, by the time I finally see a doctor, I will be 37 weeks. Fantastic. At that point, I'm supposed to be seeing the doctor EVERY WEEK.

So I contacted the nurse in charge of patient care at the MFM clinic via email. I explained how angry and frustrated this is making me and that I understand that they are busy, but that I really feel like no one is taking an actual interest in my care. Chad and I are both getting frustrated. At this point, I don't even know that I'll see an actual doctor for an appointment beyond an ultrasound before I deliver. That's so comforting. So right now, I'm just angry and frustrated. Again, I'll post updates as I get them.

Oh, and today, which is officially the end of summer, has brought snow to Colorado Springs. Happy Monday.

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