So Far At Mayo Arizona, My Nightmare With Insurance

[Lemons2lemonade]

I do not even know where to begin. I got a referral from my doctors office and health insurance company 2 months ago to see Dr. Goodman at the mayoclinic. I am now in Arizona and saw Dr. Goodman for my first visit on Monday morning. Following that appointment, I was directed to wait in a lobby so that all of the tests could be scheduled. The scheduler then called me up 15 minutes later to tell me that there had been a problem with my insurance company and that I needed to call them and resolve it before my tests could be ordered. I called my insurance company's customer service line where they told me that my referral was approved accidentally and that they were no longer going to honor it.( Are you freaking kidding me?! I am in Arizona.) I have spent the last 72 hours addressing this and only after I threatened to sue them, write my legislators, the media,called the corporate office, went through my insurance contract stating the specific violation and essentially told them that not doing this would cost them more in the long run, was a phone call made to Dr. Goodmans office. His nurse called me this afternoon and said, " I just recieved a bizarre phone call from your insurance company." I told her that I bet she did ( my letter was very frank and legally threatening including words like 5 years of misdiagnosis, fraud, good faith, written agreement, and lawsuit.) Ultimately, my insurance company called mayo directly and said something along the lines of "give her whatever she needs." Man did I have to work for it though. I probably talked to over 30 people within my insurance company including my internal medicine doctor who was awesome enough to call me back from his on duty shift at the hospital, and the assistant to the medical director(whose number and contact info I had to find on my own- I looked up the business office phone number online, talked to the drone who answers the phone at the front desk and asked to be connected to the medical director, he told me he could connect me to the secretary. ) This experience just goes to show how much you need to fight sometimes against pots and part of that fight is with your doctors and insurance companies. Keep fighting, don't give up, and you will get your treatment. The squeakiest wheel gets the grease.

[jangle]

"accidently approved" meets "accidently sued"

I like it.

Glad you got it taken care of, now get better now ya hear

[issie]

Soooo glad for you!

Now, maybe you'll get the answers you need. I guess the test start tomorrow. You go girl. Let us know how things go.

[Jan]

OMG, what a nightmare. I am so glad you pursued it and won.

[ramakentesh]

Typical eh? Just what you needed. I tell you what, i so sick at the moment I doubt I could have had the energy to pursue it. Im glad you do and did.

[julieph85]

That's awesome! I'm so glad you are able to get the tests done, it is well worth it. I'm worried though, did you get the approval in writing? I got my EOB from my insurance last week from my trip to mayo- they charged my insurance $8,500.00 and I got less tests then you. I would make sure it is in writing if you haven't already. What did you think of goodman? I love him!

[Chaos]

Glad you got it worked out.

Sounds like Goodman is taking full advantage of it and ordering everything he can! LOL Sorry you had to fight so hard for it though. That's a major drag when you're already wiped from being sick and from traveling on top of it.

Good luck with all the testing.

[chipper]

It is so hard to go through all the testing without that kind of trouble. Hope all goes good !! Looking forward to your post afterward. Love, Mary

[HopeSprings]

What a hassle, but LOVE the way you handled this! Good for you!

[sue1234]

That is great that it all got worked out! I don't think I would have had the presence of mind to do any of that.

[Katybug]

I'm so glad you got it worked out and can now have a productive trip with Mayo. And very glad you kicked some insurance bu**!!!!! Good luck with your testing!

[Trach]

I am so glad you got it worked out and best of luck on the testing!

One of my sisters is in the medical field. If an insurance company tried to deny necessary coverage for one of her patients, her most successful argument when all else failed was to threaten to report the insurance company to the state board of insurance. She says it worked every time.

One other totally stupid rule I have discovered. If you are hospitalized, approval for testing is not a problem at all. The system does not make sense to me at all.

[kmichaelson]

Good job!!!! I'm so impressed that you were able to take them on. It's infuriating that you had to go through so much hassle that to get what you're entitled to, especially when you're so sick. That's what always makes me the most upset in dealing with insurance is that they pick on you when you're at your weakest--but it doesn't sound like you're weak, and they know that now. Good luck with your visit and let us know how it turns out!

[Elfie]

That is pretty much what happened to me--- except I was 19 at the time and inexperienced/pretty ill and my family members (whose insurance I was on) weren't nearly as good of advocates for me. Basically we got "approval" only to find out we weren't approved, called the insurance to straighten it out, got "approval"--- only to come home and find out that there had been a mix up and the insurance refused to pay for 90% of the testing. Three years later I am finally a couple hundred dollars from paying that bill off.

My experience with the Mayo was positve, I got a diagnosis! Unfortunately Mayo was not comfortable beginning to treat me until I had found a doctor familiar with POTS that could continue my care locally. Mayo AZ expressed that they were not comfortable continuing to serve as my "autonomic specialists" from AZ when I lived several states away or working with my PCP or another doctor on my insurance locally to manage my care (partially because there was no neurologist for several hundred miles and only a cardiology practice, which had not heard of the disorder). Unfortunately, at the time they were the closest source of doctors familiar with the disorder.

[rubytuesday]

Good for you. I went through similar (not 72 hour drive) process when told my sub q gamma globulin was not approved by my insurance. I have been receiving IV gamma globulin and goal was to change me to sub q (much cheaper and more convient to be able to do in my home at my liesure than having to make 2 hour drive and spend 4 hours of being transfused at the center). I called my retirement company as the prescription agency who administers our retirement's plan pointed the finger to retirement system's criteria. I demanded copy of it's criteria to wage my appeal (knowing all the while my immunologist was accustomed and would get it authorized since 3 immunologists told me it was 'no brainer'). I told them it was my right. They couldn't answer other than there was no criteria--it was up to pharmacy co. to which I demanded to speak to supervisor. Super gave me same story to which I read the letter pointing out the 2 places where it cites retirement system's criteria (adding they have medical director/board who reviews/approves contract with pharmaceutical). Super tells me pharmacy has criteria and must give it to me. I ask--what happens when I call and they regurgitate this letter to me? They told me to tell them retirement system tells me it must as it pays them to administer plan. I call pharmacy. Get same story. Demand supervisor. He tells me (assures me) he must give it to his 'accountant' and would see to it that I got the criteria. He said he was off the next day but would call me on Monday (or his covering peer would call me the next day if accounting had info before his return). Never did get a call back from them (weeks ago) but did get letter that lo and behold, everything was authorized now--when nothing had changed with my condition. I was also prepared to demand that it have my case reviewed by a board certified practicing immunologist expert in both clinical and research (as is my ordering immunologist).

I would have been more than fuming. I complain to my retirement system and pharmacy administrator that it appears by practice and limits that it is survival of financially fittest--as a means of disposing of those who are chronically ill or who lack the resources or knowledge of how to appeal (leaving us to lay down and die). I truly feel sorry for those who get taken advantage of and have no idea whatsoever that they can really do something to change a 'determination'.