This Past week I have been dealing with my insurance companies in various ways and have been on the phone with them 3 or 4 days this week. On September 1st of this year Aetna took over TRS Active care from Blue Cross Blue Shield (BCBS) of Texas. Now with me seeing so many many doctors, plus being chronically ill, I didn't think about informing each of my doctors about the change until the next time I saw them. This past Monday I called my my rheumatologist Dr. C's office about what was going on in regards to trying to get my IVIG therapy started. Dr. C talked to my Hematologist Dr. CB the day of my appointment, which was two weeks ago from this past Wednesday, and she agreed to do the treatment. Dr. CBs office said that they were waiting to get approval from the insurance company. I thought it was taking so long because I had taken the treatment before and didn't really respond, and so that was making it difficult to get approved. They said they would call me back when they new more. On Tuesday, I got a call from the billing department from Longhorn Health Solutions, the company that has provided my feeding pump, pole, feeding bags, and formula. They said that there were two deliveries that had had occurred in August, totaling about 750 dollars, that the insurance said that the patient was responsible before, even though I had met my deductible. Because this problem happened before September 1st, it was while I was with BCBS, since Aetna took it over, I called them to see what the problem was. Of course I was on the phone for 10 minutes before talking to a live person and they said I needed to talk to BCBS. So they transferred me to BCBS. It was another 10 or 15 min before I talked to a real person. Because I hadn't been with BCBS for a few weeks and didn't have an ID number it was difficult to fine my benefits. I explained to the women on the phone what the problem was, and she began asking what my diagnosis was for the feeding tube. I said I had dysphagia (difficulty swallowing), which is a legitimate diagnosis for a feeding tube. I said that I needed the formula because I was 100% reliant on it for nutrition. She said that she needed to check some things out and would call me back in a max of 15 minutes. I had to go to a doctors appointment, and I waited the rest of the day and for a bit in the morning with no call back. As you can imagine I was frustrated.The next morning I called BCBS, but the first number I called was the department for individual policies, and then had to call the number for a policy under an employer, since its under my dad's insurance. It took me again 10 minutes to get through, and difficulty to find my information because I didn't have an ID number. The first lady I spoke to didn't know much about how to answer my question, so she transferred me to another woman. This woman was extremely nice and very helpful. She apologized that the other lady never called me back, and was able to give me a quick response to my answer. It turns out that the issue was the formula and feeding bags were submitted under medical, and needed to be submitted under insurance. A quick fix. She actually put me on hold so she could call the lady in the billing department at Longhorn Health Solutions and tell them what the issue was. She didn't want to have to call me back because of the not getting called back. One insurance problem solved.
I still wanted to figure out why I hadn't heard about my IVIG being approved. I called Aetna, and they had no record of that claim being submitted. They then connected me to a case manager, who proceeded to ask me why I had my feeding tube, what all my diagnoses are, and all my medications and their dosages. I really didn't feel like doing that at that time, since I was working on my online class. She wanted to call me back at around three o'clock that afternoon, but of course never did. While talking to her, I realized that Dr. CB's office may have not known that my insurance changed to Aetna, so she said that she would call them right after she got off the phone with me. To make sure that the information got relayed to them I called the financial manager at her office to let her know about the change, and they weren't aware of it. So mystery solved as to why I hadn't heard about my IVIG, and now that her office is aware of the change, hopefully we will get it scheduled soon. I also thought I had notified my pharmacy, which I'm at nearly everyday, about the insurance change, but I didn't (thanks chemo brain). But because of a new cycle my deductible hasn't been met yet, and my scrips can cost a lot, but it doesn't take me long at all to meet it.
Despite the fact that dealing with insurance companies can be frustrating, especially when changing insurances, they are a blessing. When you are dealing with a chronic life-threatening illness, its because of insurance that you are able to receive the medications you take, and see the wonderful doctors that take care of you. I know that part of the reason I'm still going, and my family is not bankrupt, is because I have insurance to help pay for all this. They may make me crazy sometimes, and feel as though there more of problem then a solution. But in the end, they are truly a blessing.
Joyful Love
&
Blessings In The Lord
Alexandra K. Acosta
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