[Cancer, Personal]
[personal|cancer] A quiet day in an unquiet life
Nothing big going on today except a Peking duck dinner this afternoon at Seres. Today is Mother of Child’s birthday, so we’ll be celebrating her there whilst enjoying Chinese food. Jersey Girl in Portland is over for much of the day tomorrow, and an out of town friend is visiting. I plan to just enjoy my weekend.
I see my medical oncologist on Monday to talk about the surgery outcomes. We’ve generated five pages of questions to discuss. Meanwhile, my health insurance carrier has again decided that my medical oncologist is out of network. This is a persistent data error at their end which no one but me has incentive to solve, so once more I am forced to hours of phone calls, and a possible complaint to the state insurance commission — or at least the threat of such a complaint — to get anything done.
Have a good weekend, and I will essay to do the same.
Related Posts
Posted: 8:23 am Sat February 02 2013 |
Where am I?
You are reading the blog of Jay Lake, speculative fiction writer and author of hundreds of short stories, many novels, and winner of the John W. Campbell Award.
Learn more here.
Comments
« [photos] Your Saturday moment of zen | [links] Link salad digests Peking duck »
May the weekend go better than anticipated, and may the insurer mend its errant ways.
I’m curious: how does one get past the “he said, she said” blockage? “My hospital says my oncologist is in network. Please fix.” “I’m sorry sir, but we don’t show him in network, so he’s not.” Where do you go after that? Other than implied threats and hair-tearing.
That’s the basic problem. Lots of phone calls and documentation. At the moment, I’m waiting for my hospital’s managed care department to call me back with confirmation that my oncologist is still under contract to my insurance carrier, because I need that info when I call the insurance company back.
Hi Jay, I work at an insurance company and you need to get a provider number for your oncologist when they identify the correct MD or “par” provider. Your insurance company can look at past billing and get that number. I can do that in less than a minute where I work. Write that number down or suggest that everyone at your insurance company write it on the back of their hands—your choice of course. PS–they checked 16 lymph nodes on my wife and all were clean (after a colon resection) and we’ll talk with an oncologist within a week to 10 days.–good luck with your insurance problem. Sometimes there are many doctors with the same name and the person checking for par providers screws up–I see it every day.
In fact, this is a different problem, almost certainly a rerun of one we had two years ago. My oncologist was correctly listed in their provider database, but there was some kind of data normalization error between the provider database and the claims database. As no one at the insurance company has any incentive for fixing that kind of problem (basically, with that error they make more money by billing doctors as out of network), it’s a long uphill haul to get anything done about it.
Yeah, I get it, but I’d still be able to fix it in short order. If claims has the correct data, your oncologist’s bill would be adjudicated at in network rates, regardless of what someone in customer service tells you. Ask to speak with a claims manager and explain your problem. They have different departments and 1 doesn’t know what the other is doing. It sucks and I love fixin’ this kind of crap where I work. I have “happy” customers instead of frustrated ones that hate their insurance company. Do you have out of network benefits and a maximum out of pocket limit per year?
My in-network coverage is pretty generous, with low co-pay and out of pocket maxima. My out-of-network coverage is punitive as hell, presumably to incent me to stay in network. (Specifically 0% coverage on out of network costs until I reach a $10,000 limit.)
Yes and if the amount billed is above “usual and customary” prices, they can stick you with that as well. You’re best bet is to speak to a manager or just report the problem to the Department of Insurance in your state. That’ll get the appeal departments attention right away. Usually, it’s not the insurance company wanting to make more money—it’s lazy worker’s who just wanna go home rather than do their jobs—–good luck, it’s easy to fix this sort of thing, you just need an advocate.
Make the complaint–don’t just threaten it. Maybe that will get them to solve their dumb data error >:/
And enjoy your weekend <3
If they *can* fix the issue, but aren’t because it’s too much work, you might want to consider making things unpleasant for upper management until they lean on the people who can fix the issue to fix it.
Low level workers often don’t have the authority to spend time fixing things like this until they’re told to by someone who’s got actual power. If you make that person’s life even marginally difficult, they’re going to want to fix the issue. Just asking them gives them the opportunity to ignore it.