Friday, February 13, 2009

State Insurance Update

Forgive my lack of creativity on this post's title...it was all I could come up with without using very bad naughty words that I don't think are appropriate for AJ to read when he's older....

I called Medicaid myself today. I was pleasantly surprised when I only sat on hold for 10 minutes.

Conversation:
Me: I'm calling to check the status of a pre-auth for a cochlear implant for my son.
Them: What's the ID number?
Me: The number is....
Them: You said this is for yourself?
Me: NO. For my son.
Them: When was it submitted?
Me: November 7th, 2008
Them: Hmmmm.......can you hold please?
Me: Sure.
Them: I DON'T SHOW ANY RECORD OF US RECEIVING IT.
Me: WHAT?!!!!!
Them: What was it for again?
Me: AAAAAAAA COOOOOOOCHLEAR IMMMMMMMMMPPPPPPLANT.
Them: No, I don't have a record of it...wait, oh, can you hold again?
Me: Yes.
Them: Oh, here it is. We SENT IT BACK TO YOUR DOCTOR'S OFFICE FOR MORE INFORMATION.
Me: When did you send it back?
Them: The 4th.
Me: Of what month?
Them: February. As soon as we get it back you should have an answer in a few WEEKS.
Me: Thank You.
CLICK.

Conversation with CI program insurance gal a few seconds later:
Gal: I happen to have your file right here. I just got off the phone with Medicaid.
Me: So did I.
Gal: We have not received it yet.
Me: What? They said they sent it on the 4th.
Gal: They told me the same thing.
Me: What information do they need.
Gal: WHICH EAR.
(Insert AJ Mom thinking, you've got to be #@&$%&% kiddng me)
Me: Which ear? That's all. I am positive that is all in the paperwork, several times, is it not?
Gal: It is. I tried to give it to them over the phone, they refused.
Me: Now what?
Gal: Well, when they send the paperwork back to us, they send it to the hospital, not Medical College of Wisconsin. To further complicate things, they send it with the patient's INITIALS, not their name. So AJ's would read A.S.
It could be in any department, and not every department opens their mail and politely gets it to the correct department. If they don't choose to open it when they see Otolarngology, were out of luck. When we receive it back, we have a week and a half to make the correction and send it back before they "void" it and you have to resubmit. I will wait for this afternoon's mail run and then regardless, I'll either fax in the correction of WHICH EAR, or resubmit you entirely. If I resubmit you entirely we have no way to track it, since it will be reassigned a new PA#.
Me: So we're essentially starting all over again?
Gal: Unfortunately, yes.
Me: Can I call and bug them this time?
Gal: By all means, do so.
Me: Ok then.
Ga: Hopefully I'll have news for you in a few days or weeks.
Me: Ok then.

This is so beyond what I can stomach right now. This is insane. Some million dollar computer system and dysfunctional case workers at Medicaid are screwing with our lives. This is not just a surgery. We have put our lives on HOLD for months. This is my son's life. A chance to give him a better life with access to the hearing world. To give him every means possible to communicate. Medicaid is so meticulous in how they want things worded that our program knows what will fly and won't. You REALLY think they would FORGET to tell you which blasted ear we want IMPLANTED? I DON'T THINK SO.

I will be making some major phone calls this afternoon to see what in blazes I can do to get this show on the road. But right now I'm going to clean up the cutie sitting next to me, covered in fish sticks and fruit loops and put him to bed.

2 comments:

  1. I don't even know what to say. That's sooooo frustrating and I can't imagine how you're feeling right now. I'm soooo sorry :( !!!

    ReplyDelete
  2. Hi~
    I found your blog through Kinnick and Carver's blog. I just read your most recent post ~ I can't imagine what you guys are going through.
    I think it is INSANE that they have sat on this for 3mths because they say that they want to know which ear. Even if it wasnt mentioned (which we all know it was)..who cares! Your child has a hearing loss ~ he is a candidate for a cochlear implant so APPROVE it!
    You will be in my thoughts and prayers that the medicaid people get on the ball and that you get your approval very soon!

    ReplyDelete

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