Wednesday, July 16, 2008

Jargon

I took Michelle's advice and call the insurance company this a.m. All I got was a lesson in jargon and patience. First I get automated menus, so I soon as I can in my best robotic voice I ask for a medical representative. OK, I get connected to an representative that can't help me, but she does inform me that the "status is pending", What the heck does that mean? So she gives me a ref. # and a phone number and sends me on my way. So with this info I call the ph. # and speak with someone else. I say I'm calling for a "predetermination" (since this was the jargon used previously, I always thought it was "preauthorization") the person on the other line says this is the wrong number for "predetermination" and she tries to send me back to the first ph #. So I say well this is the # they gave me. She looks up the ref # I give her and "OH" this is for "precertification", What ever!!! don't they all mean pretty much the same thing? So she also tells me that the "status is pending" and that the nurse is reviewing it. She tries to connect me with the nurse...I wait (they were playing some pretty good music so I'm not to irritated) after about 3 songs, the rep comes back on and tells me that she didn't answer (No kidding!) Then she says well we have 15 days to do this (which she said was past) and 15 more days to do this (we are at -9 days) So she suggest I call back on Friday. So what do I know now, not a whole bunch but some insurance jargon. I will be calling them back on Friday, I will keep you all informed.

P.S. Cure for Overcoming Panic (previous blog) Mikes hard lemonaide and soak in Hot Tub. It worked!

2 comments:

Michelle said...

Oh, the jargon! How could I forget!?! I remember talking to the financial person who works for my OS. She gave me the complete strategy of who to call and what to say. I took notes that day so I wouldn't forget anything.

Calling the insurance company is like trying to have a conversation with someone who speaks a different language. I don't really understand all the lingo, either.

You're right, though. You need to ask if your precertification was approved. The financial lady gave me the codes they use for this surgery. I had 3 codes (one for the upper jaw, the second for the lower jaw, and the third for the splint).

I also had to jump through another hoop because my OS is not in my in-network plan. I had to ask them how many oral surgeons in a 50-mile radius could perform this surgery. The reason why is because if my insurance can't find another qualified OS to perform this surgery, then they'll consider my OS as part of the in-network plan. Crazy, right?

I never would have known any of this information without the help of the financial person at my doctor's office.

Kudos for you calling, though. Those people need to be bugged in order to get anything done!

:0)
M

Anonymous said...

Hurrah for mums stepping into the breach. It sounds like Kam has a great Support Team! My own mum has been fantastic through my own surgery; I'm 5 weeks post op now and she's being my PA, getting emergency appointments for me, buying me soup, the works. She was a little apprehensive about seeing me immediately post surgery, but as it happened there wasn't much to freak out about - the truly scary bits happened to me at night when she wasn't there! :-)

Good luck and strength and patience to you both

mylene