insurance

All posts tagged insurance

Medical World = STRESS!!!

Published May 18, 2018 by lynn k scott

I have been patiently waiting for my medical insurance to decide whether they would allow a referral to a provider outside the network I am currently enrolled in.  They had 30 days in which to do so.  That’s the equivalent of molasses going uphill, on a glacier, during a blizzard.  I mean really, oncology referrals should take as long as possible because we’re only speaking of a human life.  Shoot…that sarcasm reared its truthful head again.

Even though I have completed chemo, I had no follow-up with my oncologist because she refuses to answer my questions without an appointment.  There wouldn’t be messaging capabilities if we had to make an appointment every time we needed to ask a simple question.  No wonder it takes weeks to make appointments these days.  Sorry, I digress.

It’s been very peaceful with the new job and not having any contact with anyone in the medical industry.  Yet, today, that peace was shattered.  I answered an 800 number.  The good thing is I didn’t have to go through their carrier’s horrendous hell of a voicemail system to return their call.  The unfortunate aspect was I had to deal with someone who doesn’t understand the proverbial, “you”.

While I am far from the best or even compliant patient, customer service representatives need to understand the tone of frustration compared to yelling.  It’s one thing to be sympathetic to someone’s plight of an insurance nightmare.  It’s a completely different to truly be empathetic.  Then, to add insult to injury, tell me I am yelling when I am merely expressing frustration.  There is no doubt when I truly begin to yell.  As my daughter puts it, “New York Mommy” shows up at that point.

It never ceases to amaze me how shocked people are when I say, “you have no idea” and then try to argue the fact with me that they do.  Unless the person that I am speaking with has filed multiple grievances, prepped their children for the “worst case scenario”, begged for help and to see a provider they can actually understand, DO  NOT tell me, “I understand”!!!  It’s unprofessional; to say the least.  Learn the difference between empathy and sympathy; they are not the same.

Am I overly “touchy” where my health care is concerned?  Absolutely!  Having been neglected after surgery, passed around to provider after provider and generally ignored when I insist on being in charge of my care and letting doctors only advise has me extremely “jaded” to most people.

Healthcare is non-existent.  Health profits is what drives today’s medical profession.  Patients die every day.  I truly believe insurance carriers AND providers are facilitators of this because if the patient doesn’t fit in the “acceptable” boundaries, they are discarded; regardless of how much assistance and/or treatment they need.  Nice to know it’s reached the call centers.  The entire system needs a course in compassion!

So ends another medical rant.  Off to pray for tolerance and healing.

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The doctor will see you now…NOT!

Published February 10, 2017 by lynn k scott

No one in today’s world can question the reality that the face of your medical care has changed.  With new laws, requirements, insurance requirements and medical office billing, trying to see “your” doctor isn’t always your choice.

Whether you have a chronic medical condition or just need to be seen for newly developed symptoms, making an appointment isn’t as easy as it used to be.  In today’s world, the emergence of Nurse Practitioners (NP) and Physician’s Assistants (PA) are the new “in” thing.

“Hi, I’d like to make a doctor’s appointment”.

Seem’s like a simple enough request.  After all, most of us are pay enormous premiums and/or copays for the privilege of a doctor to spend 10 minutes with us.  That’s in addition to two or three patients being scheduled for the same time slot so the doctor doesn’t lose any money, should there be a cancellation.

“Sure, you there is an appointment with Jean Smith at 3:30.”

There you go…your appointment…WAIT!  Where was the word “doctor” to go with that name?  Ahh…did you catch that too?  That’s because in this case, you won’t be seeing a doctor; but a PA instead.

Awesome.  No, not really.  I already have issues with doctors “practicing” medicine.  If I’m going to drop $45 on an appointment that a General Practitioner wasn’t able to resolve, why in God’s name would I entrust an on-going, chronic issue, to someone who isn’t even a board-certified doctor?

I don’t have the flu and I don’t need a throat culture performed.  I need a real diagnosis, made by a doctor, that will resolve my issue; the first time around.  “Oh, sorry, there are no doctor appointments available then”.  Don’t you just love the system?

Truth be told, PAs and NAs are half the price of a real doctor.  They are in even in the specialist’s office…the specialist!  Someone who may, or may not, have done any clinical work, who is now entrusted to see, diagnose and treat you, independent of a doctor reviewing their work.

Does that leave you with the same lack of confidence it does for me?  So, what are the other options?  Urgent care…yea..seeing a doctor, at double the cost of your primary’s copay only to refer you to your primary doctor.  The emergency room.  You’re in pain.  You have severe symptoms; chronic symptoms…just go to the emergency room.  Sure all the testing will be done right then.  You’ll be lucky if you only walk out owing about $2,000 as your portion of this wonderful care provided by your insurance.

All this, because carriers and medical offices prefer using under-qualified medical personnel instead of having you treated by a physician of your choosing.  After all, it’s only your hard-earned dollar that is footing this medical nightmare, right?

Tips from Human Resources

Published November 18, 2015 by lynn k scott

I did it. The worst part of Open Enrollment is behind me. We’re only 2.5 weeks past when we should have submitted the forms for our 12/1 effective date.

Here are few tips I would tell ALL employees:

1) TURN IN YOUR FORMS ON TIME!!!
2) Open the packet when you receive it – even if you think you’re keeping everything the same!
3) Please don’t say, “I was busy”, when HR calls to find out where your forms are.
4) I know it’s confusing, but if there are 3 forms, put your address on them all! It’s ok to if HR has to complete 1 or 2 addresses, but 100+ is time-consuming.
5) When changing carriers, everyone must be submitted together. When you are late, you hold up everyone! No one gets insurance on time; including your boss!
6) ASK FOR HELP when you are confused or don’t understand the forms. I smashed my crystal ball and can’t predict the future anymore. You have to be a tad proactive.
7) SIGN THE FORMS!!!! With the changing of the laws, signatures are required. Yes, yes, you’re waiving coverage. Read the first three words again; SIGN THE FORMS!!!
8) When your HR person/staff has a glazed over look in their eye(s), make sure they are adequately supplied with coffee (and not from the Evil Empire aka Starbux)!

Lucy…you got some ‘splainin to do

Published March 5, 2015 by lynn k scott

Without anyone else to walk me through the hellacious insurance nightmare, I figure Lucy could provide a better explanation than what’s been offered so far.  This is today’s exercise in futility.

  • My plan hardly has any providers – still getting those set up (4 months later…sigh)
  • We’re going to be borrowing providers from an established plan – week late on that being done….(sigh)
  • Given a name to a specialist – as my plan is able to authorize referrals without a PCP. Yet, the provider refuses to set appointment without PCP referral (catch 22 much?)
  • I don’t have a PCP because there aren’t any providers setup in my area yet (see the first two line items)
  • PCP (if available) doesn’t handle my issue – so I’m supposed to waste $25 plus lose time from work ($$$) to see someone to write a damn referral for something they don’t address, to someone who won’t see me without referral from someone not qualified to assess my issues?

So Lucy, I say again….you’ve got some ‘splainin to do.

NOTE:  If anyone would like to take on the roll of Lucy, please feel free to entertain me.  It’s really almost laughable at this point.

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