Friday, May 17, 2013

Incompetence reigns supreme

So those of you who know me, know that we've had many issues with insurance coverage for M.  Want to hear about the latest fuck-up?  (and if you have an issue with my language, please just click the little red box up to the right).

Insurance denied coverage for M to go to camp with her nurse.  Nursing company asked for an appeal and what steps needed to be taken on 4/15.  NINE days later, after I emailed to check on the appeal, we were told that it hadn't started because the MD didn't file the appeal.  Within three business days, and after being put on hold for over 30 minutes and talking to someone who had no clue what they were talking about, MD got the appeal scheduled for the morning of 5/3. 

Fast forward to yesterday, 5/16.  M goes in for a weight check (girl is putting on some pounds now!).  We find out that the morning of 5/3, insurance called the MD to cancel the appeal meeting.  When MD asked to reschedule, they were told no.  MD tried to call back and reschedule again, and they were told that they couldn't since "they didn't start the appeal."  Um, insurance told us MD was the one who needed to start it in the first place!

So after several calls - we called insurance, we called MD, MD called insurance, we called nursing, we start to get things figured out.  But oh no - I can't be that easy.  Because NOW they are telling us that the window in which to file an appeal has passed!  If they hadn't cancelled and refused to reschedule, it wouldn't have been a problem.  Needless to say, this isn't going to fly.  I think Hubby's head about exploded.

I don't know if insurance thinks we are going to bend over and take it or what.  If so, they obviously have no clue about with whom they are dealing.  I'm convinced that every person in that building shares one single brain, and that person is out back having a smoke.  In the meantime, Hubby is looking for lawyers and I am looking for state officials.  Either way, my daughter will NOT be penalized 1) for being disabled or 2) for their complete failure to do their job.

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