Frustrated and Venting

[M&M]

Hi All, I'm sure many here on this board have been in this situation - but since July it has taken me mos to get my insurance to 'pay' for my ProTime Machine.. Which they finally approved for and paid. It wasn't that they didn't approve of the need - the lady I bought it from had filed it under the wrong 'code' and had it kept getting rejected until it was submitted under the correct code.. Finally, it was corrected and the $2500.00 was paid for.. unfortunately, now they don't want to supply the 'kits' for testing as they only want to sell the 'machines''.. Getting the correct 'in-network' company for my Test Kits... has been one horrible nightmare - fighting and calling and explaining and more times than not and my insurance has said - we'll pay - just use our in-network suppliers - so I called their in-network suppliers they gave me and the product was not available with the in-network suppliers. So I call my insurance back and ask for more in-network suppliers and then I call those new networks - only to be told - they don't provide the kits either. They keep asking if it is for diabetic kits and I have to explain "no" its for mechanical valve and INR and this damn rat poison. I have to monitor it and keep it within guidelines.. This is becoming such a pain in the butt - sometimes I just want to say - NO MORE - don't pay and I'm not going to spend hours on the phone when I have to try and work at my desk and explain to these 'moron's - fine don't give me a legitimate 'in-network' supplier - I just won't take the damn rat poison and you don't have to worry. I've been so lucky in that my coumadin clinic as helped me to keep my INR monitored to this point. But I'm so 'tired' of calling and 'explaining' this to suppliers and insurance carriers.. I just don't want to do it anymore. Has anyone ever said the heck with monitoring their INR and the heck with this coumadin drug??? I don't want to take it to begin with and I certainly don't want to be hassled by suppliers and insurance companies for the 'right' supplier... I have just gotten so tired of this all.. They give me these suppliers and those suppliers don't supply !!!! What the heck is going on???

I spent my last 'annual' day explaining the 'need' for these test kits and used up 4 hours of my 'annual time' on the phone.. I am so frustrated and angry and its not like my insurance has refused 'payment' they just want an in-network supplier and everyone they 'give' me - doesn't supply.. What's wrong with these insurance companies don't they know that before they give the subscriber patients their suppliers that their suppliers don't supply this item !!!! I can't sit and argue on the phone during work hours..... and I've just had enough. I hate this CIGNA insurance.. They are so happy to say they want to help us and yet they do 'nothing' thats helpful - I just don't want to deal with this anymore and I'm not happy about taking this drug to begin with. I'm just about ready to say - FINE, NO MORE.. GO AWAY and no more 'testing'.. Has anyone ever done this and how was your INR results??

Thanks for letting me VENT... I just can't deal with with 'jerks' any longer and I'm not a 'fighter'.. I just want peace and harmony.... and of course a good road race would help immensensely right now.. Thanks for listening.. I had a great Christmas and I'm looking forward to celebrating a new year.. with or without this rat poison..

Best Wishes
Marilyn (runner)

 

[medtronic of borg]

Yo commissioner over here!

Yo commissioner over here!

Send a message to the state. Every state has a Insurance person who watches out for the public. They also have a lot of teeth, and most firms jump when they say so. But i can't remember what they are called. Help me out people. Who is it? Is it commissioner?

Medtronic

 

[tommy]

Marilyn,

See if maker of the machine will help you. They have dog in this fight. They should also be able to tell you everyone that can provide supplies.

I sympathize with the wrong code mistakes. Also, my supplies company charges taxes, and the insurance company forgets to pay the taxes even though I typed in red ink on the claim form "Remember to reimburse the taxes!" Geeesh.

Hang in there.

 

[Karlynn]

You don't happen to be speaking about United Health Care? Sounds like the exact run around I've had with them. The company they finally ended up being able to unequivically tell me was their in-network provider ended up having the supplies, but no one on staff who knew what the heck they were for. But this wasn't before being given a dozen other phone numbers that led to dead ends and then applying for a network gap exception. It's so frustrating.

Our health carrier is being switched to BC/BS and I'm told that they don't even cover the supplies.

 

[Mary]

Send a message to the state. Every state has a Insurance person who watches out for the public. They also have a lot of teeth, and most firms jump when they say so. But i can't remember what they are called. Help me out people. Who is it? Is it commissioner?

Medtronic

In Missouri, it's called the Division of Insurance and they oversee all complaints about companies that deal with your insurance. Look in the government listings of the phone book or look on the internet site.

 

[ALCapshaw2]

You're NOT alone in that hassle Marilyn.

I was the FIRST person to be covered under BCBS in my state (Alabama). It took many months but I eventually reached someone who understood what I was talking about and gave me the name and number of the appropriate person to help me out.

That was fine UNTIL I went to re-order my test strips and I was told that for my COMPANY, all DME (durable medical equipment) claims had to go through BCBS of Michigan where my company HQ is located. Naturally BCBS of Michigan does NOT cover INR testing supplies so I will need to appeal my claim (I actually did eventually locate an approved supplier who knew what I was talking about). I just have had the 'heart' to go through the appeal process yet so I continue to go to the local hospital Coumadin Clinic (which uses Coaguchek finger stick machines).

Next time you call your insurance company, ask for a Supervisor, explain about anticoagulation and hope that she can direct you to someone who can actually help.

GOOD LUCK !

'AL'

 

[Guest]

I just can't deal with with 'jerks' any longer and I'm not a 'fighter'.. I just want peace and harmony....

I'm the same exact way.

Unfortunately, some things in life don't mesh with this.

I'm very sorry about the difficulties you have and can certainly empathize with you. While I haven't had to deal with the exact issue you are, I've had my share of "jerks" with which to handle situations...and, someway...somehow...got through them without too much frustration.

*pauses*

Or, at least, that's the way it seems with 20/20 hindsite. I know I have been as frustrated as you have at times..... But, it all seems to work out....seems to, that is.....

Sorry I couldn't be of more help to ya....


Cort, "Mr MC" / "Mr Road Trip", 31swm/pig valve/pacemaker
'72/'6/'9/'81/'7, train/models = http://www.chevyasylum.com/cort/
MC Guide = http://www.chevyasylum.com/mcspotter/main.html

 

[Perrster]

Time to Turn the Table!

Time to Turn the Table!

I was twice denied coverage for self-testing even with my doctor's prescription so I gave up the fight. Now when I have to go get a PT test monthly or bi-weekly I give myself a purposeful break from work and just lollygag my way to the appointment, stop for coffee on the way back, wash the car, or take a scenic route and lose an hour or more of work time (even my employer couldn't see a cost advantage of supporting a self-test instrument-they'd rather pay insurance?!).

Thank goodness my cardio uses a Coaguchek and even has a finger prick instrument for Cholesterol tests.

Marilyn, I'd recommend reducing your stress and have fun making a little game out of it!

Happy Holidays to you and All here at VR.COM.

Cheers!

 

[catwoman]

Marilyn:

Ask your insurer about having an out-of-network supplier certified/accepted/whatever as in network, since there apparently isn't anyone in network for you.

That's what I've done with United HealthCare for QAS. There's no one in on UHC/Texas' list that provides ProTime supplies, so UHC covers mine w/ QAS as though QAS was in network. Don't remember what the insurance term for this is, though.

At least try doing so.

 

[M&M]

Thanks Everyone

Thanks Everyone

Thanks Everyone for all your support. I've just been so upset lately - its not like me - I think the stress of the holidays and my daughters wedding and now this test kits that I've been trying to obtain for mos and mos - has really 'gotten' to me.... and I was about to lose it.. and just throw the darn rat poison in the toilet and say - problem solved.. A couple weeks ago I had this terrible blood taste in my mouth - you know like after you've been to the dentist and they pull a tooth - it just tasted bloody and my INR was alittle high and I was nervous about that. I don't want to take this stuff if it can't be monitored regularly and since I'm new to it and I'm active on and off - it changes my INR and with my daughter getting married I hadn't gone to the gym as much and my INR went up to like 4.7 - but I hated the taste of the blood.. I was able to get back to the gym yesterday and they lowered my doseage by 10 mg a week and now I'm at 3.7 which is good.. and better yet I don't taste any blood...

Finally, CIGNA did agree to go outside their normal network - because all of their in-network suppliers had to be contacted and so forth and found to not have these items in stock or able to provide. QAS was first rejected from my insurance - but now my insurance is saying they will accept them as they don't have any suppliers.. But I needed my PCP to contact my insurance company and well it takes hours to get through to them and everytime I call my PCP - I get someone 'new' and they have to start all over again.. The lady who sold this machine to me assured me she would handle my supplies.. She didn't want to do that anymore. I've had more grief over this than I had from my whole 'open heart surgery' - this lady is just driving me NUTS.. she says one thing and does another. I don't even know what to expect for out of pocket expense since QAS is not in my network !! QAS mentioned to me on the phone they could ship the kits and I could pay them !!! I said: NO WAY - you ship those kits ONLY if my insurance authorizes it.. I'm not paying for these kits out of my pocket. If its done properly it should be covered 100% - but if not then I guess I'll go to my 'lab' and have them draw the blood for FREE.. I know that's covered under my insurance..

I can go and get my test done at the coumadin clinic for $10.00 each visit this year as I'm on a POS plan but next year I'll be HMO and it will be free.. of course my network is even smaller on that plan..

Its a long distance drive to the blood lab at my hospital - but I feel confident with their tests and equipment. I see my PCP at the end of next month and will go over this with her. I see my cardio (EP) next week and I'm going to speak to him about this as well. I'm only given 9 hours of sick leave a month and it takes a hour and half - (one way) to get to the lab/doctors office - I need some assistance in how I can get there without the 'sick time' and how to do it if I end up without test kits.. and need to do the lab route. I sometimes really wish I had had the 'pigs' valve inplanted instead. But I have to admit - this mechanical valve is working really good so far..

Thank You all so much for listening and giving me your advice - it helps to vent and get support and suggestions.. Thank You So Much
Wishing you all a Happy New Year...

By the way last Sunday Dec. 19th my daughter was married - she married her college sweetheart and the wedding was just beautiful... They of course are very much in love.. After he graduated from college he joined the army -and he just completed his infantry training and has now signed up for Airborne Training - then if he passes the PT training for Airborne he will get his 'orders'.. Which could be Ft. Bragg - my daughter of course will be moving out of NH to be with him.. If he doesn't pass the PT for Airborne - we're not sure where they will send him.. If he goes to Iraq or Afghanistan -we will no doubt be concerned for his safety.. He's a very nice guy and we like him alot..

LOL
Marilyn (runner)