Wednesday, January 19, 2011

Insurance Idiocracy

..A little look into my frustrating few weeks of this wonderful new year so far...

Unfortunately all Shands employees were made to switch from Humana to a new insurance starting Jan. 1. I pay more for the PPO option because 98 percent of Lucca's doctors are not at Shands because they are specialty doctors, and we obviously have to go to them lol.. Well as you all know Lucca has been going to therapy at Wolfson's since last March,...never once have we had an issue with his insurance.. So we go Jan 3rd for his PT visit and the clerks tell me that UMR (the new insurance) is saying that they do not cover Lucca's previous diagnosis of "developmental delay" and that I need a referral... First of all, I am paying BOOKOOS of money every paycheck to have a PPO out of network plan so I do NOT have to go through the whole referral process everytime we have to go to a new doctor... and second of all, 95 percent of kids are going to therapy because of SOME kind of developmental delay!! How the heck can they "not cover it." Anyway, so I have been going back and forth with therapy, insurance, and referrals about whether or not I need a referral, and whether or not I am covered and how much..for 3 weeks now! RIDICULOUS!! So when one person calls and says everything is fixed it should all be ok, the other one calls and says the insurance is telling them something different. UMR was telling therapy that I needed a referral and then telling the referral person at Lucca's PCP that we didnt.. lol OMG talk about utter frustration!! I called UMR last week and the lady told me that I didn't need a referral and I would be covered 70 percent but if I got a referral that I would be covered 100 percent, so duh of course I'm gunna get a referral! who wouldnt!? SO again, I call the referrals lady ..who calls UMR..(again) lol and calls me back saying "Mrs. McLendon, they are refusing to give me a referral because they are saying that you are covered 100 percent already so lawfully they can't give me one" SOoo I call therapy and tell them that lol.. Still not knowing which one is entirely true.. Well I find out yesterday that I need to make an appt with Lucca's neurologist (who is at Nemours) and I call and what do you know, they say that they don't take So of course I am about to have a mental breakdown because that is where ALL of Lucca's specialty doctors are located!! How can you tell me you don't take my insurance?! lol (see my frustration with this stupid ongoing cycle) So a friend (who is having similar issues) and I went over to talk to Human Resources today and basically complain and then find out what the heck is going on and she told us that if Shands doesn't offer a service (i.e. Pediatric Neurologist, Therapies, etc) and we HAVE to go somwhere else, that insurance HAS to cover at 100%! YAY! FINALLY someone who knows what they are talking about and is sure about it! I ALSO find out, that last year that I was with Humana PPO that it was the same thing, I should have been covered 100percent and they were only covering 70 percent so I better be getting some money back because I am STILL paying on last years bills!! Hopefully I will get that situation figured out but at least NOW (after 3 weeks of missed therapy) I know for sure what is going on! Hopefully we don't run into anymore issues! :)

((p.s. A day after I wrote this post, we started having the same insurance issues all over again...apparently no one has heard of UMR and they are giving all Shands patients that don't go to Shands huge problems...sooo frustrating!!))


Anonymous said...

OMG! What a mess. I wonder if you take the developmental delay off the diagnosis and put the genetic deletion you would have an easier time getting it covered. All of my therapy groups require referrals every six months. They make it really easy though. They work directly with our pediatrician every 6 months. They send him the documents to fill out and we continue receiving services. I don't even have to deal with the referral process. Our ped always puts multiple diagnosis on the referral form: genetic disability, motor coordination, develepmental delay and learning disability.

I hope everything is worked out soon! How stressful for you.

Cynthia Schauss

Lynzy said...

i wish thats how it was... ugh and after i wrote this post, the next day we are having insurance issues again..seems like NO ONE has heard of this insurance and the auth #s they are giving are bogus.. i just hope they get this resolved soon!!