Friday, July 16, 2010

In the System

Today, I had the dubious pleasure of delving into the dark world of our government-run insurance company.  Let me start off with the preface that my oldest has diabetes melitus (for those who don't know that is type 1 or Juvenile Diabetes).  It is (at this time) incurable, but can be managed with daily monitoring and insulin.  He has to see his endocrinologist four times a year, but in our insurance company's infinite wisdom he is still required to get a referral from his "primary care doctor" once a year.  Well, I just got a bill from his endocrinologist because the insurance company did not pay a red cent to him for my son's care.  What is the first thing I do?  I called the doctor's billing office.  I thought I'd check to make sure that they had submitted the bill to the insurance company before I called.  They don't work on Friday.  So, I called the insurance company directly.  Well, the rude person on the other end of the phone felt it her job to talk to me as if I were five and inform me not only was there no referral "in the system" but that I would need to go to his primary care physician and my local insurance company's office to get one.   I said, "Thank you," and hung up the phone before I said something very unchristian.  Well, after trying several local numbers for the insurance company and the medical clinic where my son's primary physician works, I decided to go there and find a real person to talk to.  First I went to the pediatric clinic where my son's doctor works.  The lady who worked there was very helpful but could not see any reason why there was no referral "in the system" but she could not find it either.  I explained that his last primary doctor said he would take care of it, and in my experience with him, he always did what he said he would.  She had another nice lady check to see if a referral had been ordered and put "in the system."  Well....she produced a piece of paper that said that his doctor had put in the referral. 
Next, I need to go to the insurance company's office down the hall.  I went to "referral management" first but she said I need to go to the other office in the next hallway.  I went to that office and she seemed happy enough to help.  She, condescendingly, told me that there was no referral "in the system."  That piece of paper said that a referral was to be put "in the system" but is not proof that is it indeed was put "in the system."  She would do me the favor of putting in an exception request just for the appointment he had over a month ago, because there was no referral "in the system."  She went on to explain how it was my responsibility to make sure that the referral had gone through.  Let get this straight--I took him to his primary doctor like I was told to do--I filled out all the paperwork I was told to--the doctor put in the request, in April mind you--that request somehow did not get "in the system"-- and I was responsible for it not being "in the system" because I didn't notice that I didn't get a piece of paper in the mail that tells me it went through.  Riiiiigggghhhhtttt.  It is all my fault.  So, after controlling my self very well, I went back to the "referral management" office.  The lady there (thanks Jean, if you ever see this) looked "in the system" to see if it was there.  Apparently, someone had tapped on a keyboard somewhere about the referral because there were "notes" on it "in the system."  However, "for some reason" there was no referral "in the system."  So, she said she will put it "in the system" and make sure it is back dated.  I have her number now to make sure it is "in the system" on Tuesday.  Because, after all, it is my responsibility to see that it is "in the system", even though I did everything I was supposed to do.  If that three hours of mental torture is not good for some time in Purgatory, I don't know what is.  Please God, don't make me ever go there again.

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