Thursday, July 7, 2011

"Are You Sure...?"

As you know, I am in a constant battle with my insurance company. For some odd reason, they do not mind paying for my scans now. Maybe it is because my health care providers fight with them prior to the actual scans, but they sure hate paying for my blood work and pathology reports! Today I received an updated Explanation of Benefits that said they are still denying my blood work from May 6th and June 10th. Soooo, I called them up. They have this game they play with me every time I call to argue about a denied claim. Let's call it "Hide & Seek: Medical Records Edition."

Customer Service Rep: "We would have to have access to your medical records, then medical management has to review it before we can decide it is not a pre-existing condition."

Me: "You have access to all of my medical records beginning in December 2010."

Customer Service Rep: "We do not have any of your medical records on file."

Me: "Yes. You. Do."

Customer Service Rep: "I am not showing any records on file."

Me: "This happens every time I call you people. You tell me you don't have my records on file, I ask to speak to a supervisor, and suddenly--boom--you find those records. So, may I please speak to someone in medical management?"

Customer Service Rep: "Please hold."

Horrible Music Begins Here....

Customer Service Rep: "Ma'am? I spoke to someone in medical management. I don't see anything in your file about melanoma. Are you sure that is the right diagnosis?"

Me: Pause.........consider screaming at her.....decide she probably does not get paid enough to deserve my yelling and say, "Every single claim since January has been for melanoma. I think I know what the correct diagnosis is. May I speak to a supervisor?"

Of course she would not pass me along to the folks in charge, but I did demand her fax number and called up to Memorial Sloan Kettering Cancer Center to have them fax over my medical file again. When I explained to the nurse why I needed my file she said, "They are denying blood work? Blood work is pretty essential to your treatment...That's stupid." My thoughts exactly!

It is almost funny how great I am at arguing with them now. I know their next step. I know that the more angry you become, the more you demand to speak to someone above them, the more they are willing to help you. Why should it have to reach that point? Why should we have to yell and curse and cry before they even consider providing us with information on how to receive answers? I understand it is a business to them. They want to save as much money for as long as they possibly can. But, there reaches a point where it is unacceptable. To deny me for a pre-existing condition and have me send in my medical records is fine. To fight with me for almost 6 months, and claim you don't have access to my records time & time again is unacceptable and unfair to me. I could be using that energy on more important things like, oh I don't know, keeping the cancer AWAY!

Siiiiiiiigh. Let's hope that they will have this problem sorted out soon. I truly do hate when people cannot do their job correctly. Or maybe that is where my thinking is wrong...maybe they are doing exactly what the head honchos want them to do. The more time they deny my claims, the more money they keep in the bank.

It is all such a game...

...& I am tired of playing it.

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