American Medicine and "UN"surance
 

I'm bloody angry, so I apologise if I offend anyone before I even start. When we moved here I began seeing a MS Specialist at a LARGE MS Clinic. Prior to our move I had an MRI, so it's been almost a year since my last MRI. At my last appointment 3 months ago, we discussed going on Tysabri as it doesn't appear that I'm going to be getting pregnant or trying anymore. We set up an appointment for the MRI, and our insurance policy reads that one does not need "prior approval" for a brain or spinal MRI.

I was set to go early this morning, as I need to be sedated. Michael took the morning off to drive me there and back, and to be at home with me until lunchtime. All was set up, and I wasn't to have anything to eat or drink for 4 hours prior to the MRI. We got up early this morning and got to the MS Center, filled out all of the paperwork, and waited, and waited. After an hour, they finally came out to tell us that I needed to have "prior approval" for an MRI and they hadn't gotten it. Now, mind you this had been set up several weeks ago. Michael spoke with the woman and said, "I looked over our insurance, and that isn't the case." We were told they couldn't perform the MRI until they had approval, so we ended up leaving. We stopped off and had something to eat, and Michael dropped me off at home before he headed off to work.

When I walked into the house, there was a message on our machine from the MS Center that they had indeed made a mistake, and we were correct; I didn't need prior approval, and if I'd like I could come right back and they'd "fit me in":confused:

Obviously, I couldn't go back as I had just eaten, and Michael had headed off to work. NOW....I have to reschedule again, because the clerk at the MS Center had no idea what the terms of our insurance were, and they didn't bother to look at them or call our insurance co. while we were at the Center.

I'm so bloody mad, I'm about to blow a gasket! Why does every insurance company differ so and make it so hard on the clerks, and why can't the bloody clerks READ????

Is it me, or has anyone else experienced something as silly as this?

Wow, Chris, I'd be bloody angry too, incompetence is a boil on the butt of this society anymore.

I did have a similar thing happen but I pitched a fit, a loud one, and got my way. They were none too pleased, but several other patients gave me a nod of approval on the way out.

Sorry you're fuming today, if it's any consolation, I broke a nail this morning. ;)

Chris

Don't even get me started on incompetence and insurance companies. The clerk at the MS center is the one who screwed up. She is lazy and just didn't bother to check. Why she didn't believe you is beyond me but she should have picked up the phone right then and there and called the pre-auth dept for your insuance company and verified. It would have taken all of about 3 minutes. Tops!

We just canx United Health Care as our primary insurance carrier through my husband's employer (he retired 2 years ago) and now have TriCare as our primary insurance as he retired military. UHC upped our premium to $1500 a month and retiered our pharmacy plan as well as several other changes which will cost us a lot more $$. We just couldn't afford it any more.

Last year, just my meds, out of pocket costs were $3000 and I am in a clinical trial so am not on a DMD. I haven't even figured out what the rest of our medical expenses were last year! So poof, fired them.

I also spent the last 2 weeks of the year getting ONE rx refilled arguing with Medco. It was so stupid. They were dragging their feet and kept coming up with one excuse after another why it wasn't getting filled. I am a pit bull when it comes to getting things done. I do not put up with incompetence. Just do your job. I got the rx filled on the last day of year before my insurance expired and they kept telling me I couldn't get it done. Ha! Wrong person to say that to!

Now I am dealing with TriCare. A whole different ball game so to speak. So far, so good. They have been very pleasant on the phone. Very helpful. The website is very organized and easy to navigate. I am getting all my prescriptions changed over and the people at Express-Scripts have been very helpful. I know that there are going to be some bumps in the road, but right now the $$ that we are saving are well worth it.

It is aggravating when people don't do their jobs! :(

Thanks you lot. This is now getting even funnier. I just got off the phone with our insurance company to tell them what had transpired. They informed me that the MS Clinic had actually called them LAST WEEK. They were told at that time that they didn't need pre-approval for my MRI! Just another wasted day in Paradise.:rolleyes:

So the incompetent clerk is really incompetent. I would definitely be on the phone to the MS Clinic having a chat with HER supervisor!

With a letter follow up making sure it is all in writing!

Sounds like the people responsible for checking to see if you needed authorization were complete morons. I bet untrained chimpanzee's can do a better job.

I wonder if you can get a discount for that person(s) lack of reading comprehension skills and their inability to write down the answer they got from the insurance company.

You can always call the supervisor of the moron and complain that they made a major screwup that cost you time (and probably money since Michael had to take off work to drive you there and back)

I went to my neuro yesterday for a scheduled check-up. Walked in, told them my appointment time, and they told me that my appointment was the DAY BEFORE!

Ummm...what? :confused:

Pulled out my appointment card, and checked. Nope. I was there on the day they said for me to be there. Showed them the card. They started apologizing like crazy. I have a new appointment for next friday. At least my neuro's office is very close to two (and soon to be three) of my favorite yarn stores. I'll be going yarn shopping (and knitting needle and crochet hook shopping) after my appointment next week. :D

I am annoyed that I have to wait another week to see the neuro. I'd made my dad schedule his cardiac cath to today because I thought my neuro visit was yesterday. (btw, my dad is doing great, and has more heart function than they said he did the other day. :D and he has no blockages in his heart! :D:) )

The letter is written and will be in the mail tomorrow.:D I really like my MS Specialist. The clinic seems to be really well run. This was the first hassle I've had with them, BUT, I've only been there for appointments so far. I'm a tad worried about starting Tysabri at their Infusion Centre.:confused:

Erin,
That seems crazy! If you did indeed have an appointment and had the card to prove it, why would they make you come back at another time? I know that on occasion we have mistakes with appointments at our front desk. If the patient even insists they have an appointment, and especially if they have an appointment card to prove it, we always will work them in, NO MATTER WHAT! There are times that they may have to see another provider because their provider is out of the office delivering, but they are all aware that this could be them someday. Our patients have to pay to park in our deck, and it's quite steep. If we can't see them we always pay for their parking just as a matter or courtesy.

I'm glad your Dad is doing better! That's wonderful news. Is he feeling better?

One thing about the Infusion Center, and I know that I am not on Tysabri, but I have worked with the system to get it set up, that they are certified and trained through the TOUCH protocol. RW can vouch for me (right RW?????)

They have a protocol to follow that is very strict. Mistakes happen but due to the TOUCH protocol they are few and far between. They have to be with the protocol otherwise the infusion center will lose their certification and ability to infuse Tysabri. The training and certification process is carefully overseen and the paperwork is tedious for all involved. It is reviewed often and tracking is mandatory not optional.

I hope all goes well for you. You can call ahead to make sure they have everything ready to go the day before as Ty is "one vial one patient" so they will know if your drug has been ordered and delivered.

Thanks, Cheryl!
I haven't even been scheduled for my 1st infusion. My doc said I needed to get the MRI first and then I have a visit with one of the nurses to fill out a bunch of paperwork. The Centre I go to only sees MS patients, and I'm quite sure they have plenty of patients on Tysabri. I was referred to this physician by my MS doc in Florida who was involved with the Anetgren trials. I was actually in the original Antegren Trial itself. So, I feel quite comfortable that he is well versed in the management of MS. I have seen his name on a few of the broadcasts that are done by the NMSS over the internet and via telephone. Thanks for the information; I shall let you know how it goes once I get started. I know that on the day of each infusion, I have to see one of the Nurse Practitioners or one of the PA's at the Centre, so they will be expecting me.

I'll vouch for Cheryl! If it wasn't for her and many other people who entered the trials, and fought to get Tysabri back, I'd be a whole hell of a lot worse off than I am right now! The Touch program is good protection if the infusion staff follows it, and so far, most seem to be being very careful.

Cheryl, The one vial one patient thing seems to have changed. I know in my case there is always an extra vial stored for me. I have heard from a neuro on another board that he orders by the half case and case now instead of by the patient. They seem to be tracking pt. and lot # or something else, because I get the vial and the box every infusion and the bar codes are the same by lot #.

Glad to hear that you are restarting Tysabri! I have had nothing but good results since I started. I hope you have the same experience!:)

Well, my neuro wasnt there yesterday. He has thursdays off. That's why they didnt try to get me in yesterday. I havent seen any of the other neuros at that office (talked to one or two over the phone) I dont really mind having to go back. It is annoying that this has happened to me twice there.

At least the yarn stores are nearby. (I stopped at one on the way home and consoled myself with 6 skeins of yarn for a shawl)

I picked my parents up this afternoon at the hospital. Drove my dad home so he could sleep off the legal buzz he got from the pain meds they give for the cardiac cath's. Then all three of us went up to a local italian restaurant and had lasagna. He is so much more calmer now. He thought he was as sick as his brother was when he had a similar problem 15yrs ago (my uncle died 12yrs ago while waiting for a heart transplant...altho, it was his pancreas that killed him....his heart was still beating as strong as it could when his pancreas killed him)

Now that my dad has been fed, watered and got to sleep off the drugs, he looks like he feels better than he has in a few weeks. His heart is healthier than they thought it was, and he had no blockages in or around his heart.

My aunt (a cardiac care nurse practitioner amd the widow of my dad's brother) told my dad it was probably from the hypertension (high blood pressure) that my dad has had since he was 15yrs old. She was right. My dad will be going to see his regular doctor on monday to figure out what the treatments for this will be. (probably beta blockers and stuff like that) He's probably also going to have to stay on his asthma medicines from now on.

At least he sounds and looks better than he has in a long while. I should have known something was wrong when he was coming home so tired that he was nearly falling asleep in his car at the red lights every night. He was having more fatigue than I've ever had.

Hopefully all the meds they're probably going to be giving him will help.

Erin
Enjoy your yarn shopping, I'm a bit jealous. I'd love to get more yarn in the house.

I'm so glad to hear your Dad's heart is better. Such good news. Give him my best.

:hug:

:) Hi Chris,

You have every right to be p***ed off about this and I think a call to the clinic administrator is in line here. You were grossly inconvenienced and for no apparent good reason. Their personnal did NOT do their job at all here.

I'm sorry you had this happen to you and would think that they could schedule you back on an expidited method rather than waiting weeks for another appointment. I know my hospital does MRIs from 6am to 10pm at night so getting in is not a problem at all. Check this out at your clinic.

Thanks you lot for your good wishes with the Tysabri and for letting me know that I am not the only one who has had such a SNAFU with the medical system and the American insurance system. Although I have been here a number of years, it seems that the problems with managed care seem to be magnified. Over in GB, we may have to wait for things, as we don't have the vast amount of technological equipment that you do here, but patients don't have to battle for their health care. It's so frustrating-from both a patient and a provider standpoint!:mad: