More Insurance Frustration

I hate dealing with insurance companies, but they are a necessary evil.  A couple weeks ago when I had my scare when my whole left side began tingling while carrying out the garbage, my doctor had written a referral for me to get MRIs on my brain and my neck.  The insurance company denied my claim because I had not seen a neurologist and we had to cancel the MRIs.

Now, the insurance company is denying a claim for an office visit for my son saying that he has met his limit.  My son's school requires that we get some forms filled out each year before he can attend school.  The new school years started July 5th, so we scheduled a doctor's visit on July 2nd to get the forms filled out.

According to the insurance company, we were ineligible to take our son to the doctor because it had not been a year since his last exam.  We started the application process for his school last summer.  He had his initial exam for the school on August 7th.  The insurance company has a 30 day grace period, so they say he would have been eligible for an exam on July 8th.  So the claim was denied for having the exam six days early.

We were not aware that we could only get a check up done once every 12 months.  I tried to explain to the customer service rep the situation with my son.  In order for him to be able to go to school, he needed the exam.  Unfortunately, they would not budge, and told me the only thing I could do was to file an appeal.  I have written and sent a letter explaining the situation, and hope that they will reconsider since we were only six days early. As frustrating as it is to deal with the insurance company, I can not imagine not having.

Related articles

• Tactics for Appealing Health Insurance Denials (thesimpledollar.com)

More Joys of Insurance

This morning, I was supposed to have my next round of tests from my episode from last Friday.  I had my referral from the doctor, and I had an 8:30 appointment at the radiologists to get the MRIs done on my brain and on my neck.  Unfortunately, my insurance company had other plans.

I received a phone call from the radiology office yesterday afternoon informing me that the referral, which needed to be approved, had been denied.  I called the insurance company to see why they were not allowing me to have the tests my doctor requested.  I was told that my medical profile did not fit for authorizing the tests.

Another thing that the insurance representative told me is that one of the reasons that the approval had been denied is that the tests were usually given to somebody who had already had a stroke to see the extent of the damage rather that to somebody to see if they were at risk of having a stroke.  This made no sense to me, as I would think they would rather prevent a stroke than treat one.

I finally was able to speak to the person who handles the referrals out of my doctor's office.  She told me that the reason for the denial was that I had not had a neurological consultation.  The doctor would have to review the documents regarding the denial and decide whether or not to refer me to a neurologist.   I am still waiting to see what will happen with that.

On a positive note, one of the things we were dreading trying to accomplish while my son has been home was getting him a dental exam for school.  The last time we tried he was very uncooperative, and we were unable to get a full exam.  This time he was able to get the exam, cleaning, and flouride treatment.  We still didn't get x-rays, but he did a great job.

Not a Happy Camper

I was not a happy camper this morning.  This morning, I was scheduled for the first of the tests that my doctor wants me to have done since my little scare on Friday morning.  I had a 9am appointment at my doctor's office to have the carotid doppler exam.  The exam uses ultrasound to measure the blood flow through the carotid arteries to the brain.  Below is a picture of my appointment card to show that I did in fact have a 9am appointment for today.  I have blocked out any identifying info of the doctor's identity.

I showed up at the doctor's office about 10 minutes early.  The office was completely dark.  The office usually has people in it prior to opening, and the door is usually unlocked a little early as well. You can imagine my dismay when I looked at the office hours sign that was posted outside of office door that showed that the office did not open on Wednesday's until 12:30.

I immediately called the doctor's office and heard the message stating the Wednesday office hours.  I pressed the button to be connected with the answering service.  They reiterated the posted office hours, but took my number and said they would get a message out to the doctor.  I continued to wait outside of the doctor's office for about 15 to 20 minutes waiting for a return phone call.  It never came.

I was totally pissed off thinking I was going to have to reschedule the test.  I was just getting ready to head home when I saw one of the nurses from the practice walking towards the office.  As she was approached the door to unlock it, I saw the technician who was to perform the test approaching with her equipment.

The test ended up taking about 15-20 minutes.  The tech said that they would have to review the images and the results would be sent to the doctor in about a week, providing they did not find anything that needed urgent attention.  Here is hoping that I don't hear back from my doctor until sometime next week.

On a somewhat related note, I was also scheduled to get MRIs performed on my brain and my neck tomorrow morning.  Unfortunately, I just got a call from the radiologists office informing me that the pre-certification for the tests had been denied.  According to my insurance company it was denied because I had not met the medical prerequisites for the test.  The test is normally given to people after they have a stroke, not to see if they are at risk for one.

I am hoping that my doctor will be able to get the necessary approval so that I can get these MRIs done.  My doctor has not yet arrived at the office yet, nor is the person who handles the referral process for him since they do not open until 12:30.  Hopefully, they will be able to talk to the insurance company to get these tests approved.  I freaking hate insurance companies.

Small Scare

I had a bit of a scare this morning.  The last few weeks, I have been starting to feel a little more run down than usual.  I attribute a good bit of it to my having put on part of the weight that I had lost earlier in the year. 

I had lost about 20 pounds by cutting out drinking, junk food, and a lot of bad carbs.  Unfortunately, since the baseball season started in April, I have been partaking of too much stadium fare.  A little bit would probably be OK, but when I fall off the wagon, I usually jump off full bore.

Anyway, back to the scare.  I was all set to head off to work this morning.  My lunch was packed, I had brewed some tea to drink on my commute.  The only thing left to do was take out the garbage.  I was walking to the curb with a bag in each hand, when all of a sudden I felt a tingling sensation all up and down my left side.

I have been having a bit of a problem with my right arm where I would experience some occasional weakness and numbness, but it usually happened if I slept on my left side or rested my elbow or wrist on a hard surface for an extended period of time.  This was different, and a bit scary.

The sensation did not last long, probably just a few minutes.  I sat in my car and debated whether or not I should head to the office or not.  Discretion being the better part of valor, I decided to call out sick to work and try to see my doctor.

I was able to get in to the doctor's office to be checked out.  His first thought is that I may have a pinched nerve, but he wants to run several more tests to be certain.  I have to go back in to see him next week when a technician will be in to run a carotid doppler exam.  I also have to schedule an MRI on my brain and neck.  He is also concerned about possible sleep apnea, so I also will need to get sleep study done. 

Hopefully there is nothing seriously wrong.    I hope the fact that the doc sent me on my way means he doesn't think it is too bad.  I definitely need to clean up my eating habits and take better care of myself.  If you happen to be of the prayerful type, I appreciate any positive words on my behalf.  We will keep you posted of the results.

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• How eating junk food destroys brain cells that control weight (news.bioscholar.com)
• I have Sleep Apnea (usurpingunencumberedness.com)