Waterboard Torture Insurance Style
Today I felt I was being placed repeatedly underwater, held there for a few seconds and then resurfacing by an insurance company. I would call it torture. And I know what I am going to be dealing with when I call a company. I do it almost everyday and have spoken with just about every different company. But today Texas Health Spring won the prize for torture beyond the call of duty. I am used to getting the run around and different information each time I call. I expect it and that is why I call sometimes twice a day on a case. Even talking to different supervisors I receive different information. I never get angry, I just get more inquisitive and question what I hear. The story always changes. I keep pushing to get the information I need or a phone number of someone up the food chain. Customer service representatives are trained not to give any information on any administrators, medical directors or utilization persons. These departments are faceless and unaccessible. These are the departments that make medical decisions and prior approvals . You can not find any information on the web sites.
Today, nine days post submission, I was trying to find out if the prior approval was authorized. The company stated policy is no more than 72 hours for an answer. But the game here, as with many companies, is either the doctor needs to submit more information or new ICD codes. This can hold everything up because many times the doctor actually isn't informed they need to submit anything. The representative (and they are all generally as helpful as is allowed) after questioning why it was taking so long, called the prior approval nurse and was told the doctor needed to send more information. Now, I know the doctor sent nine pages of documentation because I supplied most of it! And the information was medically significant. As an aside ,Texas Health Spring Does not allow it's Medicare patients to see any specialist without a prior approval and like most companies has many refusals. My story continues with me calling the doctors office who had resent all the information the day before after receiving a request and didn't understand what was happening.
In the process of talking to many players in this game, I was able to finagle the phone and fax number of the prior approval nurse. That is like winning the lottery. I called. I got an earful because the prior approval department is like the covert section of the CIA. They have their own code, rules and ethics. I stirred the hornets nest. However, the next day, approval was given. 10 days later, an elderly client will finally get the care so deserved.
My job is to know how to navigate this impossible compassionless system and get what is needed. I love it and it is my passion to find the solutions.



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