HELP!!

[Sobes]

Oh Boy!!! I'm suddenly not feeling too confident in my staff at UW Madison First they booked our hotel (it is booked through the hospital staff) for the wrong days in the wrong month and charged our account!!! It took them 3 days to credit the $$ back to our acct Second...and most recent...the surgery coordinator called me last night about 4pm to let me know that they hadn't yet scheduled my MRI for Thursday (when ALL of my pre-op is to be done) and called me back about 10 min. later to let me know that it is set for 6:45am on Thursday before all the other tests (the only time they could fit it in)...we have a 3 hour drive. She then proceeded to let me know that I need to get the MRI authorized through my insurance...WHAT??!!!!!! Of course I called BCBS immediately and they were very understanding but said the only way this would be preauthorized by Thurs is if someone from the doc's office called this am to give them the "coding". Sounded simple enough until I called this am to find out the clinics were all closed due to the storm WHAT DO I DO? THIS IS THEIR FAULT FOR NOT SCHEDULING SOONER AND I CANNOT AFFORD TO PAY FOR AN MRI IF MY INS WON'T COVER IT??? The lady at BCBS told me that it will be covered if it is considered a "functional MRI" meaning that it is required for surgery (from what I gathered). I have not been able to talk to anyone today to find out how they are coding this MRI. I know that it was the neurosurgeon who wanted it done and should have been scheduled a month ago with all of my other pre-op tests!

Anyone have advice? I am so stressed I want to cry

Bren~

[Jim Scott]

Bren ~

Oh boy.  I'm so sorry to learn of your problems with scheduling your surgery.  I often wonder if doctors have the slightest idea how much an incompetent office staff brings trouble and grief to a patient, all because some people don't do their job.  It is definitely frustrating.  Crying is allowed in this instance.

It appears as if the insurance company will approve the MRI in your case, as it is necessary as a pre-surgery function.  Unfortunately, the bad weather and the lack of coding may make a problem.  I would ask BCBS if they will approve the MRI after-the-fact.  That is, after it has been performed.  Tell your doctor that you'll take financial responsibility for the cost of the MRI if BCBS rejects your claim.  Of course this is risky but it seems as if this will be approved as soon as BCBS has the proper code. I would try to make certain the doctor's office has the proper code (pre-surgery MRI).

Barring that, you may end up having to delay your surgery until all the insurance issues are resolved.  Again, this is highly unfortunate but sometime happens when doctors and their office staff don't do their job.  Of course, I hope and will pray that this can be worked out in a way that keeps your surgery on schedule.  Let us know.  Thanks.

Jim

[Sobes]

Hey Jim~


Oh boy.  I'm so sorry to learn of your problems with scheduling your surgery.  I often wonder if doctors have the slightest idea how much an incompetent office staff brings trouble and grief to a patient, all because some people don't do their job.  It is definitely frustrating.  Crying is allowed in this instance.

Thank you for responding so quickly Jim...I am feeling...well, there really aren't any words

It appears as if the insurance company will approve the MRI in your case, as it is necessary as a pre-surgery function.  Unfortunately, the bad weather and the lack of coding may make a problem.  I would ask BCBS if they will approve the MRI after-the-fact.  That is, after it has been performed.  Tell your doctor that you'll take financial responsibility for the cost of the MRI if BCBS rejects your claim.  Of course this is risky but it seems as if this will be approved as soon as BCBS has the proper code. I would try to make certain the doctor's office has the proper code (pre-surgery MRI).

When I spoke with the gal at BCBS yesterday (immediately following the call from the doc's office), she said she thinks it should be covered but couldn't promise anything I know the surgery coordinator felt bad about this but that doesn't help my situation. I am so afraid they will deny the claim because of this So, I just spoke with someone from BCBS again and was told that not only can she not authorize it, she cannot even give "notification" of it because I don't have any codes to give her. She couldn't even tell me weather or not they would cover it after the fact.


Barring that, you may end up having to delay your surgery until all the insurance issues are resolved.  Again, this is highly unfortunate but sometime happens when doctors and their office staff don't do their job.  Of course, I hope and will pray that this can be worked out in a way that keeps your surgery on schedule.  Let us know.  Thanks.


The surgery is already authorized but apparently they also need authorization for this MRI...ugh...I just don't think I will have them do it...I cannot afford a $3,000 bill (on top of everything else)...sorry to vent... ugh

Bren~

[NancyMc]

Oh, brother, I'm having flashbacks.  Dr. Barker's assistant Mili could never do anything right for a lot of his patients who report on this forum.  You really had to do everything yourself.  It was exhausting and nerve-wracking.  We wondered if her position was actually a paid one.  She is out indefinitely, according to a new patient.  No wonder.  It's about time.
I have refused to hang up with BlueCrossBlueShield many times until I get the answer I want.  I've called their grievances department and been allowed waivers "just this one time" repeatedly.  Hang in there and advocate for yourself.  The doctor's office should make amends.
Good luck.

[Sobes]

Thank you Nancy,

Well, off to bed with me...have to leave here at 4am to get to Madison for my pre-op appt's, including the MRI that I probably won't be able to have I appreciate the support! This is so very frustrating and has me rethinking the whole surgery thing...at least having it done in Madison Nite

Bren~

[Sobes]

Jim & Nancy,

Wanted to let you both know that everything went ok yesterday. We got to the MRI check-in where I told the receptionist my concerns and the details of what had happened. She told me Dr Baskaya needed the MRI and called someone who "magically" got a hold of my insurance and got everything authorized! Whew It was such a long day. We left Green Bay at 4am and it took us 3 & 1/2 hours to get there (usually takes 2 hours and 15 min but the roads were treacherous). We did not finish with all the appt's until 4:30. It turned out to be a great day and I feel so much more peaceful about everything! Thank you both for your responses and concern. That makes everything ok:)

Bren~

[Jim Scott]

Bren ~

I'm delighted to learn that the hospital was able to coax your insurance company into paying for the very necessary MRI. That is what happens when medical staff people are knowledgeable and do their job.   I know this was stressful for you and apparently, it could have been handled sooner, as your experience at the hospital proved.  Oh well, it's all over now.  Thanks for the update.

Jim

[NancyMc]

Good news!
Onward.