Sunday, January 19, 2014

' My Doctor saved my life this week' vs 'The Insurance Co wants to Randomly deny my CT Scan'

I had some pain the other day, a real stabbing constant pain in the right lower section of my gut. Mike said, that's where your appendix is...

So since the next day was 'day two' of morning four day seminar I had paid for I made an appointment for late afternoon - 4:30.

The pain was pretty constant and annoying but really didn't bring me to my knees or anything so I made it through the day ok.

When I got to the appointment lo and behold my new insurance plan didn't have my doctor as my Primary provider. (Despite me calling numerous times to have it changed and having someone tell me from Florida Blue that he had been changed to my PCP (Primary Care Provider)

So they weren't going to see me. They called Blue and the lady said that is the way it is and wouldn't let them put me on the phone.

So I got on the phone and sat on hold for MANY minutes...Meanwhile I asked them for another phone and the phone number of the primary care provider that was assigned to me so I could try to get in. AND I told them I thought I may have appendicitis.

30 minutes later, (Still on hold with Fl Blue) I had made an appointment with the other PCP for 8am the next morning...and the Office manager came over and said that my Dr. - Doctor Fern would in fact see me. On his time and not bill for the appointment (since he couldn't) and check me out...

So laying on the table with Dr. Fern examining me the person FINALLY picks up from Florida Blue and said he would switch me to my preferred PCP but guess what... couldn't in fact do it....

Put me on hold again for about ten minutes in which Dr. Fern went to see his other final patients for the day.

When he came back I am still on the table but he starts to examine me again and the Fl Blue guy comes back on again. This time he asks if I am at Dr Fern's office and asks to speak to someone from the office.

Dr. Fern gets on the phone and took down the confirmation number and verified that he would be able to order a STAT CT scan as it appears I have appendicitis. He said that was a get on the phone himself with an insurance company WHILE examining his patient.

Then I go to the front desk and the lady calls gets DENIED from FL Blue for my procedure.

You know what she tells me? Oh don't worry I just have to call again...they randomly deny tests all of the time.


So my Dr. kept his practice open WELL after six to get this done for me and they gave me some sort of disgusting thick barium banana flavored drink to drink on the way to the ER.

At the ER since my doctor's office had pre-cleared the test and sent my stuff I am taken in to the Scan department, I am told I have to drink more goop and wait for 2 hours. They give me warm blankets and a quiet place to hang out while I wait for my gut for to be ready for the scan.

They took my appendix out at 1am rhat night. What could have happened if my Dr didn't see me that night? I could have gone home and it could have burst that's what.

I don't understand why Health Insurance companies still have so much power over our health and life and can still be so inept.

I get that they were overwhelmed with the whole ACA thing, so HIRE MORE PEOPLE! Insurance companies are one of the richest types of companies doing business in our country. Their offices are annointed with such splendor with rolling hills, statues, lakes and gated entrances that they look like country clubs.

Anyway today I am grateful for Dr. Fern. A Doctor who does the right thing and sees a patient despite the lack of correct policy in place and knows above all else 'To do no Harm'.

I just wish the Insurance companies had to follow that credo.


Jeremy Wayne Lucas said...

Having gone through a major illness for a prolonged period, I certainly can identify and empathize with your situation. It takes so many attempts and so much time to get simple errors corrected. I think most people just toss up their hands and forget it -- probably what the insurance companies want from us.

I once had surgery provided in the hospital by a wound care specialist that managed to save my right foot from amputation due to a MRSA infection by successfully carving out the infected tissue. When I had necessary follow up appointments with the same doctor at his office for ongoing home heath IV administrations and examinations, the insurance company refused to pay because the doctor was "out of network." Why, then, was he allowed to provide care while in the hospital and receive payment??! It is always like trying to pull hen's teeth to make sense of insurance company practices.

The Lovely One said...

Yikes! BUt thank goodness you were able to get the surgery!