When I got home from leg therapy on Wednesday, it was 3:30. The first thing I did was call to check on my leg pumps, as OT had ordered suggested. I didn't get my legs to how they are today by ignoring OT! In fact, she is always complimenting me for my compliance. I hope she puts that in my permanent record, heh, heh! Anyhoo... I called the number that the regional rep for the leg pumps had given me.
According to OT, the order was authorized by a physician (some guy I can't remember who oversees my NP). It went into the insurance system on June 9. At therapy on Wednesday (July 8), OT said she had tried to contact the insurance. As had the regional representative for the leg pump manufacturer, who had met with us in May. Nobody got any response. Because these healthcare entities are limited in the amount of contacts they can make with the insurance, OT said the rep suggested that I call and see if I could get a response. Indeed, back in May, she mentioned how slow my insurance is, and said I might have to call them.
I had a little note with what I wanted to ask. OT had said to mention that I had a "prior auth," and she gave me the name of the contraption that I should be getting. And to mention how it had been ordered a month ago tomorrow.
I got voicemail.
Isn't that the way it always goes? You get yourself all revved up to present your case, and then have to scramble to fit the info into a message. I think I remembered the pertinent points. I left my name, insurance ID number, and phone number.
Then I set about the business of waiting. I was sure they'd call me right back! Just as soon as a representative was available. Apparently, those folks are long-talkers. They must have talked into the night with the people they were already on the phone with!
I carried my phone with me, so as not to miss the call. To the bathroom. To the living room to consult Farmer H about his supper. Back to the kitchen. Set it beside me while finishing my scratchers. I needed to put my phone on the charger as usual, but I was afraid it would ring, and I'd be unable to rush over to the kitchen counter before it quit. THEN I'd be faced with playing voicemail tag.
So intent was I on getting this problem solved that I answered two random numbers! Just in case. My Insurance has called me from a variety of numbers, and their name does not show up. But these were just annoying calls. One wanted my opinion on data centers. We don't even have that issue in our county, though an adjacent one is battling a proposed data center. The other call was repairing roofs in our area, and quite willing to fit me in. I hung up on both. You know, because my real caller might be trying to reach me!
By 8:00 p.m. it dawned on me that I probably wasn't going to get a call. I consulted Farmer H.
"Do you think I should call back tomorrow? Or will that irritate them, and make them put me at the bottom of their list?"
"I don't know. I think I would call them every day until I get somebody."
"Yeah. Maybe I'll give them tomorrow, and then call back on Friday."
Thursday morning at 10:13, my call was returned! I could see that it was from the number I had called to leave the message. Of course I had my phone next to me! Along with my insurance card, driver's license, debit card, and the notes I had made. You can't be TOO prepared!
Insurance Gal listened to my talking points. Seems that all they were waiting for was payment. Insurance covered 80 percent, and the other 20 percent was my responsibility. That's pretty standard. I knew I had met next to nothing of my deductible this year, and that I would have to pay. Insurance Gal quoted me the price: $1172.01. She asked if I wanted a payment plan, to be billed. Or to use a credit card or debit card. I said I wanted to get it over with, and just pay it right then with my debit card.
Insurance Gal said I had to virtually sign the contract. Did I know about virtual signing? I affirmed that indeed, I do that through YourChart with my appointments. So I had an idea. She sent me an email with a link to the program they use. Walked me through it. Then she read from a script, asking me if I agreed to have my debit card charged for this amount. I did. The charge went through, and Insurance Gal said that FedEx should deliver my package in 3 to 6 business days. That I would get an email with the day and time window.
OT better be proud of me for getting this show on the road!
I don't know if this was just the time my leg pumps were finally ready, or if the holdup was waiting for payment. You'd think they would have contacted me by phone, email, or regular mail over those four weeks. Rather than leave me hangin' without knowing what was needed. Maybe it was on their schedule to call me Thursday anyway.
I still plan to take credit!
A pet peeve of mine is that MyChart doesn't let me know if there is a billing ready for payment. I was just discussing this with my husband, that our insurance lets me know they have processed a bill, which reminds me that I have an open billing due from an appointment at the end of June. Yep, no hurry there. I would pay it right after the appointment (lab only - no doctor) but it's never ready, even a few days later.
ReplyDeleteGood thing you were ever diligent getting this taken care of. You would think if it was money they were needing/wanting, they would have contacted you in some way. I assume this would also show up on YourChart, but since they don't trigger anything with new billing, you wouldn't be inclined to check either. Crazy the way these places all work and never consistent and certainly not consistent from one agency to the next. That would be just too darn simple and easy for the world to comprehend. It isn't insurance if it isn't completely discombobulating. Ranee
Rae,
DeleteThis billing notification might be something new for YourChart, because I never got notified that way before, just a paper bill from the hospital/clinic. The first time it happened was when I went to the orthopedist for my knee in March, and it showed up for the x-ray fee there in his office. Then my leg therapy co-pay for May, which showed up at the tail-end of June. So I'm expecting a couple more of those.
I don't think my leg pump bill would be on YourChart, because as OT says, the manufacturer is a third party vendor. So the hospital/clinic doesn't get any cut of that money. But surely my insurance could have found a way to notify me. They usually send a statement saying THIS IS NOT A BILL, showing what they paid, and my remaining responsibility.
Or maybe it's just the vendor itself who is in no rush. Then again, it might have been a 30-day kind of thing, and they would have contacted me anyway the next day.
The whole insurance approval thing baffles me, as in nothing getting done until insurance approves it. It's so different here, after any appointment I swipe my insurance card, it pays its share, then I swipe my debit card to pay the gap. Done. I don't know about any equipment being ordered/provided as I have never yet needed any, but I know it wouldn't have to be "waiting for insurance approval" Doctor would order, I would pay, they would send it then I would make an insurance claim and they would refund me within the week.
ReplyDeleteRiver,
DeleteI wish it was so easy here. Every insurance company has a different agreement over how much is allowed for specific procedures. Then there are levels of coverage within each insurance company, which determines what percentage you pay. The insurance gets billed. Hopefully it responds in 30 days. Then the medical provider bills the patient for what cost remains.
Forgot to mention, Medicare also pays a share of almost everything, only dental is excluded from Medicare and boy are we annoyed about that!
ReplyDeleteRiver,
DeleteYes, Farmer H and I are old enough for our Medicare here. It pays a negotiated amount, then we have supplemental insurance to cover what's left. But we have a certain deductible amount that we must pay every year before the full amount is covered. We can get supplemental plans for dental and optical.
Medicare starts here at birth, children are automatically added to their parents cards.
ReplyDeleteRiver,
DeleteHere, medicare is for people 62 and older. Then there's medicaid, for low income people. Age doesn't matter. Many of my students were on it.