14 November, 2010

Why do I feel like I'm always battling with doctors?

Or insurance?


This time howver, it's not Tricare's fault.


I've been seeing a dermatologist for almost a year now. He's a former Army doc, but now serves the civilian population as well as Tricare Prime patients. That's where I come in!


I really like him. He's to the point, gets things done, and has actually done wonders for my complexion. I want to keep the guy around.


Most of you know how Tricare works for specialists. You go to your PCM, get a referral, Tricare approves it, and viola, you see your specialist. 


Do we all remember what happened with Tricare last month? Read about it here and here...


I had a visit with my dermatologist in July. They decided to push my visits back to 3 months since I had been responding to my medication. That put my next visit the first week of October. I go to that visit and they up my script, so they decide to put me back at one a month visits. No big!


I get the explanation of benefits from Tricare a couple of weeks later with both the annual appointment (which was shown to be totally fixed and zeroed out, thankfully!) and the visit in October to my dermatologist. It shows I owe a deductible. 


Great, Tricare still hasn't fixed their system. I put it on my to-do list and let it go. I haven't received a bill from the dermatologist so I have every reason to believe it's Tricare again. 


I go to my appointment on November 1. The doctor bumps me back up to every 3 months. I schedule my appointment and as I'm about to walk out the door, I remember I wanted to ask about my referrals. I wanted to make sure that I was still covered. I knew I only had a certain number, but I wasn't sure where I stood.


So I stop and ask the receptionist "Oh, one more question!"


Receptionist: "Sure, what's up?"


Me: "How many more referrals do I have?"


Receptionist: "Oh! I was just looking at that. It looks like you have two more after today, but that all of them actually expired in July."


Me: "What?"


Receptionist: "Yeah, you'll need to get another referral from your primary care doctor before your next visit in January..."


Me: "Uh. Okay. Thanks."


This woman booked me for TWO different appointments, fully knowing that I had no referrals to go with them. And she was about to book me for a third without even mentioning it to me. Had I not asked, I never would have known.


And then guess what shows up the next day...The bill for my visit in October. You know, the one I wasn't covered for but that nobody wanted to tell me about? That one. And now, I've got another bill coming. This one for 54 dollars. Bringing the grand total up to 96 dollars. 


I'm calling the office manager first thing tomorrow. Part of the job of the doctor and their office is to verify that my insurance and referrals are CURRENT. So that I can see them. Without paying. And if my records show my referrals are in fact, not current, they are supposed to tell me before I show up for my appointment. 


Thankfully, I know a few people that work in insurance billing, coding, and authorizations... And they have told me everything I need to tell the office manager tomorrow. Including the fact that I am ready to alert both the doctor and Tricare that his employees are just forgetting to tell people that they aren't covered and are therefore collecting payments from patients that they shouldn't be... I'm hoping it doesn't get that far, but I'm ready to go that far if I have to. 


Wish me luck, everyone. The last time you did, things were squared away in 10 minutes. Send me those good vibes again!

2 comments:

  1. Oh no fun! I hope everything works out and that its an easy fix. Sending you good vibes :)

    www.life-itssomethingbeautiful.blogspot.com

    ReplyDelete
  2. Did you get it all figured out & fixed?!

    <3BoardieLove, Cami

    ReplyDelete

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