The Mind of Bluesleepy

Shock to the system 4 December 2008

Filed under: Uncategorized — bluesleepy @ 11:51 pm

Wow, that’s a shock, to log onto WordPress to post a new entry and be confronted with a completely new posting screen.  I like it, though!  It looks a lot more clean to me, and I like how wide the posting box is.

I love upgraded software.  Heh.  It takes so little to please me!

I’ll tell you something that isn’t pleasing me right now.  My insurance company.  Like most active duty people, we have Tricare Prime.  I enjoy it because we have zero in the way of co-pays, as well as no-cost prescriptions.  The only thing we pay for is $10 or so a month for dental insurance for Grace and me.  Everything else is covered.  I can’t complain.

But every so often, there’s a monkey wrench that’s tossed in to mess everything up.  And lately, that’s exactly what’s been happening.

I need a small procedure done, nothing to worry about.  My OB that took care of me while I was pregnant with Mary Ellen has talked to me about it, done the initial consult while I was still in the hospital, and is ready to go with me.  The thing is, my maternity care ran out the instant I gave birth.  The only other appointment I had approval for was for my post-natal care.

Dr. C told me that it’d be no problem, that all I had to do was call Tricare to set up an appointment with my Primary Care Manager (PCM) to get the referral for the procedure, and it would all go through.  Kurt tried doing that, but then Tricare kept telling him that he’s not the one responsible for getting the authorization.  Instead, Dr. C should call this number to ask for the referral, and to give “continuity of care” as the reason why she was going to perform the procedure.

Yeah, fine, whatever.

Dr. C wasn’t convinced this was the way to go about it, but she was game.  She called me yesterday to tell me she hadn’t forgotten about me, but that she’s been calling the number that Kurt gave her, and she keeps getting an answering machine.  She’s left her information several times, but she never gets a call back.  She told me she’d keep trying, but that’s where she is right now.

I explained that to Kurt, and he decided to call Tricare again to see what the deal was.  Here’s where things started getting annoying.  The Tricare rep that he talked to yesterday told him that whoever gave him the prior information about Dr. C asking for the referral was completely and utterly wrong.

That’s the problem with dealing with Tricare.  It’s a nationwide company, though it’s split up into different regions depending on where you are stationed in the country, which means you have no idea who you’re talking to at any given time and whether they really know what they’re talking about.  So frustrating.

This meant that Kurt had to start over from the very, very beginning with a whole new Tricare rep.  This one told him that we’re very unlikely to get authorization for the procedure because it’s something that can be done by the military doctors or by a doctor contracted by the Navy that works at the clinic here.  There’s no reason for them to outlay money for a civilian doctor to do it since a military doctor would cost them nothing.


I have nothing against the military doctors, I really don’t.  It’s just that I already have a relationship with my OB.  I really like her, I trust her, I’m comfortable with her.  I just want to continue being seen for this one last thing.

This morning I had an appointment with my PCM — only it wasn’t her, just a nurse in the same department.  She said she totally understood what I was asking for, and that it wasn’t unreasonable, but that it was unlikely to be approved because Dr. F in Family Practice does the procedure.  Tricare hates shelling out money for things they can get for free.  She told us she’d put in the referral and sent us off to Referral Management a few hallways down to ask for an authorization number.

We sit down with the lady at Referral Management, and she clicks away at the computer and begins giving me the steps to making my appointment with Dr. C once the authorization go through.  At this point, Kurt and I are just looking at one another because so many people said it wasn’t going to be approved because Dr. F at the clinic could do it for free.  So finally I screwed up my courage and pointed that out to her.  The lady said it shouldn’t be a problem because no one at the clinic does such a thing anymore, and even asked another woman in Referral Management the same thing who confirmed that no one at the clinic does such a thing.

Here I am getting told by Family Practice that Dr. F does the procedure, but Referral Management is telling me no one at the clinic does it anymore.  So who’s right?  I believe Family Practice, but since Referral Management has pushed through my authorization to allow Dr. C to do it, I’m not complaining.

I called my doctor this afternoon to tell her what was up, and even her nurse confirmed that Dr. F does the procedure since she used to work for both Dr. C and Dr. F before Dr. F went to work at the Navy clinic.  But the nurse seemed confident that things would go through with Tricare, even still.

We’ll know for sure tomorrow.  Dr. C’s office should get a fax tomorrow with my authorization number, which means I’ve gotten approved.  I’ll just keep my fingers crossed.

But damn!!  Does it have to be so hard?!


7 Responses to “Shock to the system”

  1. beanie Says:

    ahhhh good old government red tape!

  2. cardiogirl Says:

    Getting referrals for medical treatment really sucks. I understand why they do it, but it’s always a pain in the ass.

    Hey, is it really necessary to upgrade WordPress? I’m on 2.2.2 and I’m afraid of the upgrade. Change is bad, remember?

    JD over at I Do Things just got hacked and she was on 2.6.3 and highly recommends upgrading to 2.6.5. Oy vey, all these numbers.

    I suppose the answer is to back up everything and upgrade with fingers crossed. Which version are you on?

  3. art Says:

    i will never understand the shenanagains the insurance companies pull!!! hope you get approved!!

  4. terri t. Says:

    Being from an insurance background and having to deal with supervisors and others in home offices who have NO CLUE what the real world is all about….I can tell you that there has been remarkable progress made for authorization of your procedure. Consider yourself lucky if the dr. you really want gets to do the job.
    I once had a claim for a little league ballpark where the gate was broken down and items were stolen. Stupid supervisor told me the extra paid-for-coverage for F.e.n.c.e.s. did not include a GATE. I had to go over his head to Dept. head to get auth for a $200 repair bill!

  5. Elle Says:

    I’ve wrangled with insurance company goofons as well, mostly homeowners’ claims for hurricane damage. Some were sublime and some were just bloody damn ridiculous. We went through something like 8 adjusters after the storms of ’05.
    Well, did they let you go to Dr. C? Did they? Did they??

  6. Boxx Says:

    I haven’t had any medical insurance in 6 months! Luckily , I stay healthy. *New* insurance should kick in as of the first of the new year. (sigh of relief)

  7. michele Says:

    YOU’D BETTER call me and tell me what this “procedure” is! I mean, after all, I *am* your seeeeeeester!

    Love you!

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