Insurance Company/Doctor Fiasco -- YIKES!

Discussion in 'Fibromyalgia Main Forum' started by Mar19, Mar 5, 2006.

  1. Mar19

    Mar19 New Member

    As of the beginning of the new year we've had a new health insurance carrier, two actually. One for prescription coverage and the other for doctor and other medical concerns. DH's employer dropped the carrier that we used for over twenty years. So far it's been a total nightmare!

    I'll try to summarize the details -- which if written in their entirety could rival War and Peace! First off, the pharmacy benefits had my birthdate entered as 01/01/04 -- it took six weeks and countless phone calls to straighten that out and get my correct birth date entered. While the bad date was in, I was unable to get any of my Rx's filled b/c, according to their files I was 2 years old. *YIKES* when they did add the correct birth date, they didn't take the old one out -- that meant some of my Rx's went thru, some didn't. That's all fixed now. (Thank you, Lord.)

    At the end of last year when we were choosing which company to sign on with, I researched the three choices we had quite thoroughly and we made our decision based on the fact that "Company X", while it specified we exclusively use in-network providers only, had all the doctors that dh and I currently use or would conceivably use. It cost more out of pocket each week, but co-pays, benefits, etc were such that it would be the best possible choice.

    I've been going to the same primary care doctor for 20+ years now, and have a rather complicated medical history (don't we all with these dd's?). I would have never signed on if I had to change doctors. Surprise! Surprise!!! I had an appointment on Jan 25, and to make a ridiculously long story short -- my doctor's information was left in the health insurance system in error. His practice stopped dealing with them 4 years ago. That means if I continue to see him I'll have to pay out of pocket, or I'll have to pick a new doctor and try to get him up to speed on what's going on.

    The latter choice poses a big problem. First off, my chart now consists of three "volumes" -- each the size of a phone book; and the meds I take have been settled upon after *years* of trial and error. The former choice, staying with my current doc, has the problem not only of paying for all visits ourselves, but if I need to be hospitalized again, I'd need an admitting doctor... Would the hospitalization be covered if the insurance company doesn't cover the admitting doc??? *YIKES*

    To make matters worse, I *did* call the doc's office numerous times before and after the new year to see if they took this particular insurance. I guess no one really felt like actually checking b/c I'd get answers like "I think so" or whatever. One of the clerks in the billing dept (after my visit on 1/25) told me that they did take it. The office manager has agreed to write the charge off for that date, but that doesn't solve anything long term, does it? *YIKES*

    The frustration level is pretty high right now. I had called both the insurance company and the my doctor's office since the end of last year, trying to ascertain that all of this was going to work out, it's only in the past week that the reason why everything was so messed up was discovered.

    At least everyone at the new insurance company has been very pleasant to deal with -- not at all like the old place. They've started an appeal to see if anything can be done, since it was their mistake that caused the whole mess.


    My doctor is being very helpful too. He and I talked on Friday for quite a long time on the phone. He's sending me written prescriptions that I'll need for the coming month and is going to write a letter that I can bring to whatever new doctor I choose. It's just going to be almost impossible to dump my rather complicated case on a new doc like this. Again -- *YIKES*

    Just what any of us need on top of the day by day struggle of dealing with these DDs, eh?

    Love and blessings
    Mar