I never realized how much time I spent on the phone - not chit-chatting with- friends, but making appointments, doing staffings, the neverending calls from therapists/Residential Treatment Center (RTC) staff, and of course the endless waits to speak with- insurance company and various vendors. Now that I work and have to account for my time, I know how I used to spend my days. So much for bon-bons and soap operas...
I finally got the giggles today, and the smug know-it-all (not) who happened to be at the other end of the phone was none too pleased. Long story short, Boo's wheelchair is about 5 years old and needs some replacement parts. After a ridiculous conversation with- vendor who for some reason has not kept records of the parts they used when they *built* the doggone thing or of the parts that break annually, requiring a visit to our home to figure out what to order, get script from MD (are you *kidding* me??), then pre-cert with- insurance (wrong), then order parts, then take my son's chair for who knows how long to do the repairs (not going to happen)... I called the ins co to take care of this pre-cert business because while I know we have to pre-cert before getting a new chair (due to customization, the cost is equivalent to a nice car), we do *not* have to get pre-cert for repairs. I thought this would be a simple 2 minute call. Silly me.
Mr. Smug, who works in the pre-cert department, informed me that vendor must submit work order with codes so ins co can decide *if* they need to pre-cert. I said, no, actually that's not the case - this is repair, not a new chair, so I just need to get from him verification that pre-cert is not necessary. He was adamant that he had to have the billing codes. In other words, they pre-pre-cert to decide if a pre-cert is needed. Which is when I got the giggles. *Then* he made the mistake of telling me that I obviously don't understand what a pre-cert is. I was just howling at that point, thanked him, and hung up.
I started my adult life doing medical billing/insurance. Not only that, I have been dealing with- HMO/PPO paper chases for 16 of Boo's 18 years. I *know* what I'm talking about here.
Long story short, I finally got confirmation that no pre-cert is necessary (from a nice guy in member services who *I* got giggling after I told him for the tenth time that he was a genius and a saint among men, LOL). After dipstick vendor showed up to look at chair (OMG, hold me back), without the most important part that I *know* for a fact is generic and is sitting on their parts shelves, I fired them and found another vendor who promised me he will at least keep a list of the frequently broken pieces. And I just had to call Mr. Smug's supervisor because... I hate being treated like an idiot. I totally admitted to her that I had probably not helped the situation by laughing but that one must appreciate the theater of the absurd when it happens. I also suggested that perhaps Mr. Smug should: a) be fully aware of the policy provisions of husband's company (Smug works on a phone line that is exclusively for husband's company - not a lot of different provisions to understand) before he starts spewing ridiculousness and b) if Mr. Smug feels a subscriber "doesn't understand" pre-cert, perhaps he should do his job and explain it rather than dismiss said subscriber as a lost cause. Supervisor could have been trying to placate me, but she did get the concept that there is no pre-cert for replacement parts. There is a "notation" now in our file that medically necessary replacement parts (ie anything besides a new seat cover because Boo wants a different color) do not require pre-cert.
Time down... almost 3 hours. Practical end result? Bupkus. Zip. Zero. Nada. No parts, no repair. Do have the glimmer of hope that new vendor will be a common sense kind of guy but... impossible to be hopeful for too long given past experience.
Tomorrow's task? Fighting with- Residential Treatment Center (RTC) affiliated hospital who is billing us for group therapy because they have repeatedly failed to obtain (you guessed it) pre-cert, *and* dealing with- mental health insurance company who refuses to speak with- me regarding said bills because thank you is over 12 - a gross misunderstanding of HIPAA and IL statues on their part. I'm guessing at *least* 3 hours. :smile:
on the other hand - thank you's home for a visit until Sunday.... :hypnosis: Maybe I *should* let insurance talk to him. :rofl:
I finally got the giggles today, and the smug know-it-all (not) who happened to be at the other end of the phone was none too pleased. Long story short, Boo's wheelchair is about 5 years old and needs some replacement parts. After a ridiculous conversation with- vendor who for some reason has not kept records of the parts they used when they *built* the doggone thing or of the parts that break annually, requiring a visit to our home to figure out what to order, get script from MD (are you *kidding* me??), then pre-cert with- insurance (wrong), then order parts, then take my son's chair for who knows how long to do the repairs (not going to happen)... I called the ins co to take care of this pre-cert business because while I know we have to pre-cert before getting a new chair (due to customization, the cost is equivalent to a nice car), we do *not* have to get pre-cert for repairs. I thought this would be a simple 2 minute call. Silly me.
Mr. Smug, who works in the pre-cert department, informed me that vendor must submit work order with codes so ins co can decide *if* they need to pre-cert. I said, no, actually that's not the case - this is repair, not a new chair, so I just need to get from him verification that pre-cert is not necessary. He was adamant that he had to have the billing codes. In other words, they pre-pre-cert to decide if a pre-cert is needed. Which is when I got the giggles. *Then* he made the mistake of telling me that I obviously don't understand what a pre-cert is. I was just howling at that point, thanked him, and hung up.
I started my adult life doing medical billing/insurance. Not only that, I have been dealing with- HMO/PPO paper chases for 16 of Boo's 18 years. I *know* what I'm talking about here.
Long story short, I finally got confirmation that no pre-cert is necessary (from a nice guy in member services who *I* got giggling after I told him for the tenth time that he was a genius and a saint among men, LOL). After dipstick vendor showed up to look at chair (OMG, hold me back), without the most important part that I *know* for a fact is generic and is sitting on their parts shelves, I fired them and found another vendor who promised me he will at least keep a list of the frequently broken pieces. And I just had to call Mr. Smug's supervisor because... I hate being treated like an idiot. I totally admitted to her that I had probably not helped the situation by laughing but that one must appreciate the theater of the absurd when it happens. I also suggested that perhaps Mr. Smug should: a) be fully aware of the policy provisions of husband's company (Smug works on a phone line that is exclusively for husband's company - not a lot of different provisions to understand) before he starts spewing ridiculousness and b) if Mr. Smug feels a subscriber "doesn't understand" pre-cert, perhaps he should do his job and explain it rather than dismiss said subscriber as a lost cause. Supervisor could have been trying to placate me, but she did get the concept that there is no pre-cert for replacement parts. There is a "notation" now in our file that medically necessary replacement parts (ie anything besides a new seat cover because Boo wants a different color) do not require pre-cert.
Time down... almost 3 hours. Practical end result? Bupkus. Zip. Zero. Nada. No parts, no repair. Do have the glimmer of hope that new vendor will be a common sense kind of guy but... impossible to be hopeful for too long given past experience.
Tomorrow's task? Fighting with- Residential Treatment Center (RTC) affiliated hospital who is billing us for group therapy because they have repeatedly failed to obtain (you guessed it) pre-cert, *and* dealing with- mental health insurance company who refuses to speak with- me regarding said bills because thank you is over 12 - a gross misunderstanding of HIPAA and IL statues on their part. I'm guessing at *least* 3 hours. :smile:
on the other hand - thank you's home for a visit until Sunday.... :hypnosis: Maybe I *should* let insurance talk to him. :rofl:
