Thursday, January 17, 2008

The 7th level of hell - health insurance company policies...

At this point I'm not really sure who is to blame. I have spent the better part of the day making or waiting on calls about getting Tysabri approved for my husband. It doesn't help that there are so many parties involved in this process. There are the people at Biogen (the manufacturer) and I have yet to actually get his case manager on the phone so I get someone else's interpretation of her notes. There is the doctor's office - they have done everything they were supposed to do but are still trying to help figure this all out. There is the Infusion center - they can't set up an appointment until the insurance approval comes through. There is the insurance company (who the case manager I can't get in touch with has been speaking to). There is my husband whose short term memory is shot and who is stressed and confused and can't remember who said what. Finally throw me into the mix, I have authorization to speak on his behalf to all but the Infusion center because he hasn't actually become a patient of theirs yet so we haven't filled out all the necessary HIPPA privacy forms.

So here is my day - 1st call to Dr's office - spoke to confused secretary who told me to call Biogen. 2nd call to Biogen - can't get our case manager so speak to whoever is available and find that everything has been sent from dr's office and tells me to make appt for Infusion center. 3rd call back to Dr's office this time speak to billing manager who knows what is going on and she really helped me. 4th call back to Biogen to direct line for case manager (given to me by billing manager - bless her!) but got voice mail. Left detailed message and asked her to call me TODAY. Waiting on that call - after which I may have to call the Insurance Company myself to figure out WTF the hold-up is.

The problem has to do with us changing insurance companies on 12/1/07 and then requesting a therapy that costs $30,000 a year. Normally they approve this drug - BUT they have a pre-existing condition clause, they will waive this if you can show that you were covered continually under a different plan with no lapse of coverage. We did this - form was faxed on 12/21/07 should be a DONE DEAL. Then they needed preauthorization forms from the doctor which he faxed on 1/4/08 - again should be a DONE DEAL.

If it is indeed a done deal no one has informed the infusion center so they will not schedule an appointment. There are just way too many cooks in this kitchen and I can't figure out who's burning the sauce and I'm getting pissed!

So friends, this has been my day - in between working at my real job that pays for the uncooperative insurance and the rest of my bills.

Now I have to pee but I'm not leaving this desk until the case manager calls - enough is enough!

1 comment:

verybadcat said...

Wow, that sucks. What a goosechase. I guess the infusion center is probably smart not to book appointments without insurance verification, but it's not so patient friendly. Good luck and Godspeed.