June 24, 2011

checkin the facts

Do you check facts- look into things even though people might tell you something and sound completely certain? The girl at my doctors office made inquiries with my insurance company the other day to confirm coverage for a procedure.

She, while I was undergoing treatment checked to see if I could have three different types of grafts and all weren't covered she was clearly certain. To say the least the doctor and I were unhappy, this news easily could add weeks if not months to my treatments and healing process.

I wasn't pleased since this my first experience being denied coverage in 30 years with the same company. I even wrote a post about it no-way-not-chance-denied. I will say maybe that post might have been a bit premature. I should have checked my facts, something I usually do; I was remiss.

After stewing about it for a few days, forming my arguments pouring over all my coverage and finding no such exclusion I decided to call and inquire about two things.

1. did she receive the right information from the right place.

2. if she did receive the right information and grafts weren't allowed, was there a process to challenge my coverage and if so how?

Well guess what? I called both sections of my company; checked both the hospital and doctor coverage  thoroughly and guess what? After lengthy phone calls they have no record of an inquiry the other day    ( they keep records of all calls and inquiries) they get logged into the system by insurance ID number. *curious*

There is a process in place it takes 14-30 days to get everything pre-authorized;  since it's not an ordinary/common procedure, I've opted to do this. A few quick faxes with a bunch of info and hopefully we'll be in business. My doctor's gonna be happy Monday when I tell him!

So now instead of having to worry about all this insurance nonsense maybe now I can start worrying about whether a skin graft is as painful process; does anyone know?


  1. Oh My!! I would be asking some pretty serious questions of my doctor, in regards to the person who was suppose to take care of that. And I would be wondering who else she's made mistakes with and they never did due diligence like you and just suffered with the consequences. So glad you don't have that to worry about. I never had any experiences with skin grafts or knew of anyone who did, sorry.

    I hope you are healing quicker than ever!! Have a great weekend!

  2. Not the first time they've did something because they "thought they knew my coverage".My coverage is from NY not VA so they don't really have a clue Michelle.

    With my home nursing if I didn't double check behind the wound center staff and make a call to my insurance myself I'd be paying %50 for the home nursing and that cost $135 per visit 3x weekly instead of getting it for free.

    I'm so excited my brother and his family are coming on Thursday for a week. You have a good weekend too, mine is cleaning and getting ready for the invasion!


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