Those of you who know me know that events rarely pass without me having something to bitch about. Physical Therapy was, apparently, not going to be an exception. I was not only ready but actually excited about my first PT visit. After weeks of being immobilized and not being able to use my left arm I was eagerly anticipating moving forward and side to side, for that matter. I knew it was going to be a lot of work and possibly a lot of pain but it also meant progress toward my goal.
To this point, I've had very little trouble with my health insurance company. Actually, I've had no trouble. All throughout my pre-op, the surgery and my post operative visits I've not heard a peep from the insurance company. Everything has been approved and I just flowed through the process, effortlessly. This was about to change.
I wound up choosing a Physical Therapy clinic in my neighborhood in Brooklyn but it was not my first choice. The list my surgeon's office sent me with the recommended PTs was quite long but I soon found out my choices were going to be limited. Although there were a whole slew of places listed in Manhattan, they were several locations for one practice. What that meant to me was that when I called and one location did not accept my insurance it eliminated a whole group from the list. Also there were one or two places that listed my insurance as being accepted but when you called they said they took "out of network benefits." Translation: they don't take the insurance. The list suddenly became very short.
After weeding out the facilities that were of no use to me I settled on a practice. They accepted my insurance and they had locations through out Brooklyn including one in my neighborhood. I called Wednesday and was not able to get an appointment until the following Thursday because I needed an evening appointment. The receptionist took my insurance information and I just knew I had 8 days to wait. I placed a call to my insurance company to inquire about the number of visits I was allowed per year and to ask if there was anything else I needed to know. I was told 60 and all seemed well.
Thursday came and I was excited as I left work. I was highly motivated and ready to get in there and put my time in. As I boarded the bus at 4:20 pm to make my way home, my cell phone rang and I checked it once I sat down. The call was from the receptionist at the Physical Therapy Clinic.
She felt this was the appropriate time to call and let me know that I would need a referral from my Primary Care Physician or they would not be able to see me. When I asked why she was calling me an hour and a half before my appointment to tell me this when she had my insurance information for 8 days she responded "Well, we're very busy here and I just got to call the insurance company." To add insult to injury, I would not be able to be seen for another week unless I was willing to take time off work, which I was trying to avoid and also why I had waited a week for an appointment in the first place. AHHHHHH!!!!!!
I called the insurance company to verify that I needed the referral. Turns out I did but I could also get it from the surgeon. Still pissed, I called the surgeons office and with it being after 4:30 I was greeted by the answering service. No help there. I called my PCP's office. The good news was they were opened until 5:30 that day, the bad news was that I got voicemail. I left a message explaining my plight and continued ranting to anyone who would listen. Erik wound up getting an earful over IM. Thanks, again, for letting me vent.
Luckily I got a call back from my doctor's office. They heard how worked up I was an called the PT office for me and worked it out. They called me back and told me that I had my referral and it had been faxed to the PT office. I would get to keep my appointment.
I was happy but I was still annoyed that I had to deal with all that aggravation to get there. Two things in particular annoyed and continue to annoy me. The first is that I got the call about the referral so late. I know all these offices call the insurance the same day but a call at noon would have easily resolved the issue instead of my scrambling to find an open office at 4:40 PM. Secondly, when I called the insurance company the rep did not mention anything about a referral. I didn't specifically ask if I needed a referral but I did ask if there was anything else I needed to know and was told "No." If either person would have stepped up and put forth a little more effort I would have been saved some grief.
I went for my appointment and all went well with the evaluation.(I will post another, non ranting, entry with details about my evaluation.) As I was leaving I asked to make an appointment for my next visit and I was told that I now had to get authorization! Does the madness ever end? I asked the receptionist how long that would take and she said it could take 48 hours after it was submitted and she would submit it the next day, Friday. I made appointments for the following Tuesday and Thursday and went home, knowing that I was going to aggressively follow up if I wanted to keep my appointments.
Monday morning came and I called the PT office around 10 AM. I was greeted with confusion and asked if I could be called back. "I have charts everywhere and I can't find yours right now." It didn't exactly inspire confidence, yet again. Much to my surprise, I got a call back within the hour only to be told that my request for authorization had not been submitted because she was out sick on Friday and she would submit it now. Things were not looking good for my keeping my appointment.
I followed up by calling my insurance company on Monday afternoon to be sure they had received the request and they had, so that was a step in the right direction. I then called again on Tuesday morning and afternoon to follow up on the authorization. Finally, I got approval on Tuesday afternoon so I would be able to keep my PT appointment. You would think this would end the frustration, but no.
Someone sitting in an office somewhere had decided that I was authorized for 8 sessions during the next 6 weeks and any further visits would require further authorization. This was in spite of the fact that my surgeon had prescribed 2-3 sessions per week for the next six weeks. So if I decided to attend the bare minimum number of sessions they were undercutting my prescription by 4 visits. When I pointed this out I was told that this is just how it is and I have no choice. I expressed my frustration to the customer service rep at the company and explained the frustration I had experienced already with the PT office being on top of following up on this stuff and that I did not have the greatest faith in their diligence to keep up on the paperwork and that this was impacting my recovery. I also pointed out the insanity of having to jump through so many hoops to get a authorization for PT after surgery that they authorized and paid for. The rep, while compassionate, could do nothing.
I now called the PT office to let them know I would be keeping my appointment and about the authorization had received. I was informed that the fax machine was down and, as a result, they had not gotten the authorization. I told her the situation and she said they could get a verbal authorization if they needed to and I asked her to make a note in my chart. I was also told that it would be easier to get authorized for further visits since it was a part of continuing care. I'm not convinced but I guess I don't have much choice. I'm sure there will be another health insurance related rant down the line.
The lesson learned here is to do your homework. Ask questions when it seems there are no questions to ask and when you're given an answer, ask again. In spite of all the doctor's and medical professionals you may be working with, you are the one responsible for getting what you need.
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