It must be "give me the runaround" week...

kkh2002

First...Synagis.  My primary insurance approved DD's Synagis as expected, but they also approved having home health come out rather than us going to the pedi every month.  Only with home health, we have a $350 deductible that will start over after the first of the year.  DD has Medicaid because of her birth weight so I asked them to submit the charge to Medicaid.  Well that delayed us a week.  After a series of phone calls I found out that Medicaid is dragging their feet because my pedi is not a Medicaid provider.  Fine, whatever.  I'll go to the pedi once a month, but I don't have $350.  Just send the freaking medicine to the pedi so we can get the vaccination.  She's already 4 days late for her dose!!

Runaround #2.  I submitted receipts to my primary insurance for my breast pump rental and purchase a month ago (after verifying that rental/purchase for a preterm baby is covered under my policy) but have yet to receive the reimbursement.  So I called customer service yesterday only to find out that they need insurance procedure codes from ME to process it.  Thanks for telling me a$$holes.  I called the lactation department at the hospital where I rented and purchased...they have no idea what codes I need and tell me to call my OB.  I call my OB...they have no idea and tell me to call the pedi.  I call the pedi...they have no idea and tell me to call lactation.  Dude!!  That's where I started!!

Runaround #3.  We have a reflux related prescription for DD that needs to be compounded.  We had it filled one month ago, filed under our primary insurance and Medicaid covered the co-pay.  We refilled it today and Medicaid denied it because it's compounded so we had to pay out of pocked.  WTF?

It's a damn good thing I no longer have a job because I'm not quite sure where I would find all this time to advocate for my daughter's health!  If someone doesn't call me back with some info I can use I may lose it!!

 

clyoungsey

here are the codes they gave me:

Equipment E0603

Engorgement:  676.24

Prematurity  765.10

hope that can help..

clyoungsey

medical in general stinks...((hugs)) your way

goblue

That stinks.  I have found that if I just wait, things sort themselves out.  DS is on both my insurance and DH's and we are always getting forms that say they need this or that or they are denying something.  I used to call and get frustrated and try to send them what they need, only to find out they had just gotten it the day before from the other insurance company.  So now I just ignore the statements and things seem to be working out. (I know this can't continue, but for now, i'm riding it! ) For example, pedi's office called in early November to say both insurance companies had denied Synagis (not too surprising because this is year 2).  Then in late November I get a call from a pharmacy saying I need to authorize a $100 co-pay and they will send out the Synagis to my pedi.  I agree, and then when DH took DS to get the Synagis shot, the nurse told him there was no co-pay because secondary insurance had agreed to pay the $100.  I think our karma is finally starting to turn.  Good luck with everything.