A patient with a military insurance plan calls up and says that she had a foreign body removed from her eye and was instructed to see an eye doctor the day after discharge, but she made the mistake of calling ahead to her insurance company to see where to go, how much it would cost, etc. She found out the following:
The insurance will pay nothing unless the ER doctor who referred her to the clinic fills out Form X and faxes it to the claims office. It will then take Y days for it to be reviewed and approved.
"But this was an emergency visit, and I can't wait that many days for a review. My eye is patched up, and I need an exam. He is not my regular doctor anyway."
"It doesn't matter, you must have the emergency doctor sign the form and fax it back."
I told her to see if they'd accept the discharge instructions with the referral information on it. Nope, she said, she already tried that. The form had to filled out.
She had apparently been calling three times or so a day for the previous two days to see if the doctor was working, and, as per our policy, no one would disclose to her if he was working that shift or not. Finally, after two days of trying, she got me, and I tried to help her because she sounded like someone who had just been dicked over by the government and nothing more. Obviously, ER doctors don't usually fill out referral forms, but I said to fax the form to our fax machine, and I'd give it to the doctor to sign. I figured he wouldn't care. She said, great, she would go to an office supply store and fax the form.
By the time the form arrived, the doctor was gone for the day.
This poor girl had already gone a week with no eye exam. Maybe he'll sign the form next week, maybe not.
Friday, June 20, 2008
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6 comments:
I HATE Tricare/Champus.
The hospital where I currently work has still to the best of my knowledge not been paid for a surgery my daughter had in 2001. Tricare keeps telling them that it was not preapproved. The surgeon was (and was paid within 6 weeks), and Tricare admits that the preapproval number covers both the doctor and the facility. However they still insist that the hospital was not preapproved. The logic (or lack thereof) is absolutely mind-numbing.
And even if the hospital were paid, all they'd get for it is about $350 dollars of the $2800 billed. (It was a same day surgery for ear tubes and a tonsillectomy.) The hospital has already spent far more than that just on the billing office's time.
I hate insurance companies.
My HMO is no better. I had surgery in March of '06, and after a year and a half or so of "Ooh, you guys filed this wrong, we can't pay you...file it like this. Nope, sorry, that's wrong too", one of the surgeons wrote off several thousand dollars, because it just wasn't worth it anymore to keep his staff fighting with the HMO.
I have tricare and fight with then occasionally, although I will admit, they were fabulous about the IUD. Sometimes I love them, sometimes I loath them.
Ps, small rant: I hate it when people lump tricare in with medicare. Huge difference: My husband has a job fighting overseas.
An IUD is a non-emergency birth control, not really the same...If there's a hassle about that, there will probably be a hassle about everything.
What are the various types of health insurance programmes that are available to me, and which is best suited to suit the needs of my family and myself? How do I choose the ideal health care plan? What are the major points that one needs to bear in mind while buying Health Care Insurance Policy? http://natural-health-care-information.blogspot.com
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