Life just isn't fair. If you have an HMO (in case Paul doesn't know, HMO is a type of health insurance), you might has well go straight to hell without collecting your 200 dollars!
I THOUGHT the wildchild was getting her tonsils out on the 6th. I THOUGHT her pre-op stuff would be tomorrow! This is what I get for thinking!
Here's the scoop. About 6 years ago, we moved to a town about 20 miles away from our home town. Our home town is a fairly small town. The town we moved to is bigger and that is where Bossman works.
Anyway, we never changed the children's pediatrician. We LOVE our pediatrician. He is awesome. He is caring and knowledgeable and doesn't make me feel like a complete idiot. We've had him since the kids were born. We decided to keep him. Driving 20 miles to the doc isn't that big of a deal, besides, my kids are usually very healthy!
So, our doc recommended an ears, nose, throat, specialist for the wildchild. Did I say recommend? I meant referred. With HMO insurance EVERYTHING has to be referred. So, he referred us to 2 doctors in the small town. He can't refer us to someone in my town because they have no contract with anyone in my town. That's fine with me, like I said it's only 20 miles away. The first doc he referred us to is booked solid until 2020. Ok, not really that long, but we were going to have to wait until the end of July. The doc called to try and get her in earlier as the tonsils are the size of golf balls. No dice. They put us on the cancellation list, but after a week of waiting the doc suggested going to another doctor. So we call referred doc number 2. This time we only have to wait a week for an open appointment! Hooray! We get in to the doc last week. He is shocked by the size of the tonsils. He rushes the surgery and everything was set.
Now, brace yourself, here comes the problem. These docs are in the small town. They have a small, but nice hospital that they do the surgery out of. Guess what?
My HMO insurance does NOT have a contract with the hospital in this town. The day after the surgery was approved, it was revoked. That's right, it was CANCELED!
WHAT?! So, after calling everyone and their brother, (if your phone rang, it was probably me) I found out that we have to start OVER. We have to go to a larger city that is 50 miles away. BUT, we have to get an appointment with the specialist first.
Who said I wanted a do-over??? I didn't.
This all happened last week. After complaining to everyone I could think of, I got an appointment for today! I'll be trekking the 50+miles to see this new specialist, so they can take 5 minutes to look down her throat and say, "Yes, Grace, the other doctors were correct, those tonsils need to be taken out." Then we will make an appointment for the surgery.
Of course, this means there will be a pre-op appointment that I will have to take her too. Did I mention that it is 50+miles away? Then there will be the actual surgery. Did I mention that I will have to drive 50+ miles for that too? Does anyone realize how much gas costs here in CA? Oh, lets see, right now, it's about 3.40 a gallon.
On top of the whole mess is the fact that she is suppose to start school on the 15th. She is going to be a senior and she will just DIE if she can't go to school on the first day. (Ok, those were her words not mine) We had the surgery scheduled so she would be done by the time school started. NOW, who knows when they will schedule it.
I did some more complaining yesterday and the lady there said she would see if we could schedule the surgery so that she won't miss school.
With the way this is going, the poor wildchild will have tonsils the size of golf-balls until she's 30.
At least by then, she can handle her OWN insurance problems!
Ahhhhh...the joy of parenting! Ain't it great?!
Oh yeah... insurance in these states really, seriously sucks!!!!! Hoops, hoops and more hoops... hang in there Grace! We are all here for you to rant, vent, blow off steam and otherwise scream at or to until this is resolved. Speaking of the wildchild, how is SHE handling all of this? And how is she feeling????
ReplyDeleteLove you,
Tiggs
For 17 years I did medical administrative work. I was the person in the doctor's office who had to wrestle with the insurance companies. When HMO's started coming into the picture, everything and I mean everything changed. People were no longer viewed as humans, they became numbers, bottom lines and commodities. I watched good doctors forced to accept less and less for their services while the premiums went up and up. I watched patients being shuffled and made to wait until the bureaucratic BS had been satisfied. It made me angry and sick of being a part of a system that forgot why it had been implemented in the first place... to serve the patient.
ReplyDeleteSo yes, I'm sitting here with a shoulder that's yelling at me right now because I don't have insurance that will allow me to seek any sort of medical attention. It's not life-threatening, just hurts like hell, so I'm doing what I can. You on the other hand have a child that needs to be taken care of and the sooner the better.
Dang, I am really irked that they're doing this to you. What a complete waste of time, energy and money.
Rant on, Grace... you have many sympathetic ears. I hope WildChild is feeling better soon.
ciao bella~
CeeCi
ps~ Cute little ping-thing! Is it helpful?
I am a nurse, but my entire job consists of paperwork, regulations, and securing appropriate reimbursement for skilled rehab facilities. I think what they've done to you is terrible, and I agree with Ceeci about insurance, I'm about sick of it myself. So I feel for you, Grace!
ReplyDeleteHuggs,
Reesa
Grace I hate this for your family- what an asinine system! Should you ever find out the individuals that started all this crap I will help you hunt them down with the implement of your choice!!
ReplyDeleteHugs,
PK
OH Grace! How I understand those insane insurance loops. It is the dumbest thing on the planet! Of course, the doctors don't have rights at all hospitals either. That stinks too. I hope they get you taken care of FAST!!! And that the insurance pays for your gas!!! haha.. won't that be the day.
ReplyDeleteTake care,
Hate this is happening to ya...
Carye
Rant on woman was that you that called the other morning at 3am?
ReplyDeleteYou forgot about the part getting to your regular Dr's office for the referral appointment at 3 sitting there till 4 going back to the exam room and waiting another 30 minutes.
AHHHHHH
*hugs and grins
Grace, I really feel for you, that's terrible, and thanks for the explanation. We don't have insurance problems, but plenty of others which I won't load you with.
ReplyDeleteI just hope that everything works out for the Wildchild, isn't it strange just how fragile they are at that age when it's to do with peer pressure,"I'll just die if that happens". *G*
Warm hugs,
Paul.