Posts Tagged ‘HMO

03
Jun
10

Warning…Off Topic

This is 100% off topic, having absolutely nothing to do with art or anything else that I normally rant or vent about here. But since this is my place to get things out of my system, this has got to be addressed.

Does anybody understand how healthcare works? Seriously. Do the doctors? The referral people. The providers, or at least the people who answer the phones for the provider?

Here’s the thing. For over two months, I have been trying to go to a specialist – chronic headaches are not something I would wish on anybody. First, my PCP’s office bumbled and fumbled things so that they kept losing my request. Then I was given information that nullified everything that had been going on, like say, “Oh, you have to actually have an appointment before we can process the referral.”  Like that info wouldn’t have been helpful a month ago?!?

Then I got a manager involved.  See, I hate to complain.  I don’t like to yell at people.  It’s not in my nature.  But seriously, one month?  So, he got in on the act, and then we kept going.  Finally, today, a very nice woman told me that I had authorization.  Woo Hoo!  You’d think I’d be over the moon, right?

NO.

I go to make my appointment, and the nice receptionist tells me I should double check my coverage to make sure that my treatments will be ok’d.  So I call my lovely health care provider.  Not for the first time.  We’ve become quiet familiar as I’ve tried to work through this whole escapade.  And see, here’s the kicker.  First, I get a guy, who politely tells me that he has no record of my authorization of anything.  Nice.  Call back to my doctor’s office and this saint-of-a-woman takes the time to go find out exactly what has been authorized.  I get all the terms down (because it’s like learning a whole new language, from NPI numbers to in-network to PCP to National Provider ID numbers to out-of-network — when was I given the handout on how to decipher this stuff?!).  Call back to the provider.  Here’s the real winner of a moment.

I have an HMO plan, and according to this lady, NOTHING out of network is ever covered.  Ever.  Cause that would have been helpful TWO MONTHS AGO!!!

Not that I believe her now.  After completely freaking out, calling my husband crying because now my headaches will never be treated because we can’t afford to pay out of pocket for all of this, I’ve become rational enough to realize that she’s got to be talking out of her butt.  Really.  How could two months worth of doctors, referral specialists, other phone operators at the provider’s center not say that one sentence to me.

My underlying issue with this entire process.  WTF.  Why is this difficult?  And why am I the one to jump through hoops and make phone calls?  Why doesn’t anyone give me the same answer twice?  Why hasn’t any of this been standardized?  Why isn’t there a little hand-out when you go to a new doctor that says, to get a referral, do x, y and z?  Thank god I took some initiative a month ago and got a preliminary diagnosis that I paid for out of pocket, mostly because I couldn’t function some days my head hurt so bad, so that my headaches are manageable, and some days I don’t have any.

But imagine if I hadn’t been able to do that?

Constant pain for two months.  And everything I do to resolve the situation, to be pro-active is nullified by the stupidity and ineffectiveness of the system and the people who work the system.  There. Has. Got. To. Be. A. Better. Way.

I’d almost rather go back to the days when I was waiting tables for a living and went to doctors when I needed to and paid for everything out of pocket because I didn’t have any insurance.  A little scary, sure.  Did my Dad hate this whole set-up?  Why yes he did.  But did I get things done when I needed to get them done.  You bet your sweet bippy I did.

And now, I’ve wasted two hours on this nonsense (just today, mind you), and I STILL DON’T HAVE AN APPOINTMENT!!!!

But that’s all the time I can waste on it today.  Life continues.  Back to the intricacies of the art world, which before this, I thought was confusing and deliberately obscure.  Now I have a new perspective, and it looks positively open, honest and glorious compared to HMO’s and doctor’s appointments.  Bring it on, Chelsea.  I’ll take you anytime.

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