Do I Look Like a Circus Dog?

Do I look like a circus dog? No, I didn't think so either, but apparently most everyone in the medical field thinks I do because they make me jump thru hoop after hoop in order to get any accomplished.

Yesterday, I called Blue Cross/Blue Shield (Kai's primary ins thru his dad) to find out 2 things: 1) If they had in fact approved the surgery (since Health Alliance said as long as BC/BS pays on it, then they will pay the remainder and I would not have a co-pay for Kai), and 2) Why they had not yet paid for the nearly $8000 CT scan back in June.

The lady I spoke to there, Marci, was very nice, polite and helpful, but dang, why can't anything be not complicated? She said they had not paid on the CT scan because the hospital had not given them all they had asked for. So, I asked what they needed. She said "medical records". So I asked her to be more specific, was it the diagnosis w/ the CPT & HIPPA codes or what. She repeated she needed "medical records" Well, I don't think they need every piece of his medical record. All they need is the justification for the need for the CT scan and that justification should be no more than the diagnosis , explanation of what Loeys-Dietz is and the recommedation for treatment and follow up. Don't you agree? So, anyway, I said, "well, if you don't have what you need, then let's just conference call the hospital and find out why they aren't providing the necessary information. She agreed, we got ahold of someone at the hospital who transferred us to someone else who told us that she had mailed the docs back on July 30th, but could have faxed it had she been given a fax number. Now, why wouldn't she have been given a fax number? She would have rcvd a written request and I am sure that written request had a fax number on it. This is not 1950 anymore. And how difficult would it have been to call and ask for a fax number anyway? Ok, so she said she would fax it over.

As for the 1st question, Marci tells me that she can see the approval for the 5 day in hospital stay, but couldn't see where they had approval for the surgery itself. Again, hello! If you have a hospital stay planned, do you think it would be for sickness or do you think it would be for a surgery? I just don't understand why people can't use common sense. So, we called Karen, the insurance coordinator for Huddleston's office/hosptial and she said she was given the approval by XXX at BC/BS and had the reference number she was given. So, Marci asks the other gal if she that person that she got the ok from was in Provider Services or Member Services. It was Provide Services. Well, Marci is in Member Services and can't see the Provider Services notes on my son (the dependent of the insrd). How stupid is that? My son should only have one account and everyone who has information regarding him, should be able to enter and read notes regarding him. If the customer service rep in Member Services can't see Provider Services notes/approvals, then how are they servicing the member? I'm not a provider so I shouldn't be pressing "1" for the Provider Service line. I guess the next time I want to know information that Provider Services has, then I will just press "1" and act like I am a provider.

That was just the first phone call yesterday. The 2nd one was to Carle Clinic for a $65 bill I keep getting for Date of Service 10/26/07. Yes, 07. It is 10 months old now. I can not count how many times I have called both Carle Clinic and Health Alliance on this very issue. On the date of service, I paid my $20 co-pay. BC/BS paid Kai's dad $289, then he paid me, then I paid Carle Clinic. Then Health Alliance paid Carle Clinic $125, but not w/ a paper check. It was like an electronic payment or something, I was familiar w/ the word she used, started w/ "Cap". I have had HA call CC, they explained they had already paid it and gave them the date and reference number. CC says that they can't find the payment so they are making HA "prove" the payment and they have not given them the proof. But, CC says they just demanded that proof less than 45 days ago and most ins companies will wait to the end of the 45 days to respond and not to worry. I explained to the lady at Carle Clinic that every time I get one of these bills, I have to start making phone calls to get it resolved and not only do I not have the time to mess w/ stuff like this, I do not need the stress of it. They have been told where to look for the payment. What I didn't say, but was thinking is, how hard can it be track down a payment when you are given the DOS, account number, patient name, and a reference number? OMG! I feel sorry for the poor sole who gets the brunt of my frustration when I finally have reached the boiling point and I finally blow my top.

Today, I went to Kai's school and met w/ his teachers, counselor and the nurse. Everyone was very helpful. I will pick Kai up from school on the 3rd and we will bring all his books home so he can take them to his dads when he is discharged from the hospital. They will email him and cc me his homework from the 4th thru the 16th. Bryan will pick up Kai from Kai's dad on the 16th, then the Homebound teacher is supposed to start coming on the 17th. They gave me a form to have the doctor fill out and get back to the district special services office as soon as possible so they could get a teacher lined up. I called Huddleston's office to ask them if it was ok to fax it to them or should I fax it to Sharkey's office. Huddleston's office said Huddleston would need to fill it out but he wouldn't fill it out until the surgery. I explained I needed it before the surgery so the school could be looking for the teacher. They insisted it would not be filled out until surgery. So, I turn around and call Sharkey's office. They emphatically tell me that they can't fill that out because it has to do w/ surgery and they are not the surgeons. How difficult is it to fill out a piece of paper that has the diagnosis on it and what the "expected" duration of absence will be? RRRRRRRRRRRRRRRR!!!!

Last Sunday was our quarterly Marfan meeting and I made Bryan, Kai and Linnea go w/ me this time. I wanted everyone to meet Bryan and see Kai and Linnea again. Kai was totally unsocial and sat in the corner reading a book w/ his IPod on. I really wanted him to at least sit and listen to what people had to say. One lady had already had open heart surgery, so her family was giving us some very valuable information to think about. The few things that they said was to get an elevated toilet seat and a shower chair. In addition, might want to elevate whatever recliner/sofa you sit in regularly because it is hard to get up out of a chair. She said her breastbone hurt for 4-6 weeks and 7 yrs later it feels like the wires are getting closer to the surface. Man, that is gonna suck! Another lady in the group has a daughter that just had spinal fusion surgery and said that we could probably use her shower seat, they would probably be done w/ it by the time we needed it.

Why do I write about the hoops I have to jump thru on a daily basis with this whole situation? There are a couple of reasons. I happen to be lucky enough to be medically savy and have had to learn over the years how to handle medical/insurance issues and I want all of you to be able to take your own medical issues into your hands and be the driver on your health bus. I also hope that by telling you everything we have to go thru, you will understand when I am stressed out and may not be pleasant to be around or may not answer your emails or phone calls. It would be nice if someone who reads this would be in a position to make a difference in the lives of patients who are dealing w/ medical isssues. I have often wondered if God gave me this knowledge in order to become a patient advocate, but I don't think I could afford to take that kind of job and although it certainly would be challenging, it's not the intellectual challenge my mind craves. I am happy to help where I can and give advice when I can and I guess that will have to be enough for now. Maybe when I retire, that can be my job.

The only other big news is that I have found another place to stay, Haven House. The only draw back is that it is 15-20 minutes west of the hospital. They do provide shuttles to/from the hospital at 7:30, 12:00, and 4:30, provide breakfast at 7:00 and dinner at 5:00. And they said if you can't be there for dinner, then they would save it for you. They have wifi access, a computer room, and a gymnasium. They staff social workers to help you deal with stress (think we'll need that :-) There is no waiting list, we are in, and it is only going to cost $30-$35/night!!!! I need to call the hospital and find out if we drive there and park, if we will get our parking validated. The parking fees are horendous!!!!!!

I know I should post here more often so each blog would not be a book, but I can only bring myself to do this so often. I just feel like I need to veg to destress. I tend to get worked up when I am writing these blogs. It brings all the emotions back to the surface.

Kai goes to his dads this weekend and Bryan and Linnea are going to Bryan's dad's this weekend. I get the house all to myself from Friday night thru Sunday night. I am so excited. I am going to Evelyn's birthday party Saturday night. I am hoping that I will get a little cleaning done this weekend as well. We all have Monday off and I am taking Tuesday and Wednesday off as well to have time to wrap things up before we have to leave on Thursday.

Ok, time to go to bed now. As Paul Harvey says, "Good Day!"