16 November, 2010

So... what happened was...

I called Tricare as soon as I woke up and explained what happened to the woman on the phone. Her first response was "Whaaaat? WHY would they see you without making sure you were authorized?" to which I replied "EXACTLY!" 


She told me that they couldn't do a retroactive referral in this case, so my best bet would be to file an appeal with Tricare. I would have to write them a letter explaining what happened, state my case, and then see what they decide. I say thank you for your help (She was really nice!) and call the doctor's office. 


The first thing I ask for is the office manager. 


Receptionist: "Oh, well, that's the doctor and he's with patients."


Me: "Oh. Well, can I have his voice mail then?"


Receptionist: "I'm sorry... who are you?"


Yeah. She went there people. She went there. 


Me: "My name is [Mrs. S] and I'm a patient there and I have some major concerns about how my referrals and insurance and authorizations are being handled."


Receptionist: "Well, that would be a billing issue [YEAH, okay lady!] but they're not here until 10:30, you can leave a message there..."


Me: "Fine. Thanks."


So I leave my message at 9:05 am. At 12:15, nobody has called me back so I call them. 


I explain to her what happened, that I never would have shown up to one, let alone TWO appointments, without a good referral. To which she tells me I need to get a referral to see the doctor. Yes, I know. I HAD referrals. But they expired in July, your receptionist never told me and scheduled me twice more without them. If I KNEW that, I would have seen my PCM in order to get more referrals... you know, like I did at the beginning of my treatment with you people...


Anyway!


She tells me to call my doctor and get them to send in a referral for those two days (Yeah, retroactively...) and then they'll resubmit the claims.


I then ask her if they can hold my 42 dollar check in good faith and hold my account so it doesn't fall into default while I get this sorted out. She tells me that SHE doesn't see the checks, they go somewhere else and they are credited immediately. 


Really lady? You can't notate my account? 


At this point, I'm silently fuming and I say thank you and get off the phone with her. 


I call Tricare just one more time to make sure that they can't do a retroactive referral... Nothing's changed. They can't. 


I wrote up my appeals letter and mailed it off yesterday. I'm done playing games. 


The problem lies in the fact that the doctor pretty much kicks ass. He's good at what he does and he's the fourth dermatologist I've had since I was 15 and the only one who has been able to produce results. So I will keep seeing him because of that. 


But... he will find out about his staff. Whether I tell him in person or I somehow get a letter or email to him, he will know that not only are they rude, they are not doing their jobs correctly for whatever reason. According to my aunt who I talked about on Sunday, some staff do it so their numbers look bigger. The more money that comes in, the bigger their bonuses are. Really. 


The receptionist charged me a copay at my first visit. I had never seen a specialist before so I was none the wiser about it. At the next appointment, she informed me that I didn't have a copay and that "it would all balance out in the end". Whatever that means. 


That's what really makes me suspicious... Are you meaning to tell me that I was their very first Tricare Prime patient...? That she didn't know I didn't have a copay?


Something is rotten in Denmark. And something tells me there is a good chance the doctor has no idea. 


So at this point, I'm going to pay the deductibles and let Tricare sort it out. If they rule in my favor, I'll get the money back and if not, I'll deal with it. In my own way. 

1 comment:

  1. Ugh. TriCare and doctors annoy the bejeezus out of me. I hope you get it all sorted out!

    ReplyDelete

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