Monday, August 2, 2010

Conversation with my Insurance Company

I love online help. You can document the convo for future reference. Or for blog posts.

Jolyn> Welcome to TriWest Healthcare Alliance Contact Center, this is Jolyn, Customer Service Representative. How can I assist you?
Sarah26> I have questions regarding referral # 0000000000. There is a car icon on the referral, are my travel expenses covered? If so, does it cover everything, ie food, gas, hotel?
Jolyn> Please wait while I check your eligibility and review your question. This should just take a moment.
Jolyn> TRICARE allows reimbursement of reasonable travel expenses related to health care, for Prime beneficiaries referred to a specialty provider more than 100 miles from the assigned PCM’s office.
Jolyn> Reasonable travel expenses are the actual costs incurred when traveling such as meals, gas/oil, tolls, parking, and tickets for public transportation (i.e., airplane, train, bus, etc.). You must submit receipts for expenses above $75. You are expected to use the least costly mode of transportation, and government rates will be used to estimate the reasonable cost. The actual cost of lodging (including taxes and tips) and the actual cost of meals (including taxes and tips, but excluding alcoholic beverages) may be reimbursed up to the government rate for the area concerned.
Sarah26> Ok. Thank you! Another question, I show that the referral reads as "Point of Service", will I have to pay a deductible or a percentage of the cost to see the doctor and any tests that are done?
Jolyn> Yes it it states Point of service it is a $300.00 deductible and you will be responsible for 50% of charges.
Jolyn> Is there anything else I can help you with?
Sarah26> I am seeing the Doctors at Mayo because they are the only neurologist that really know about my condition, Devic's Disease. My neuro in my area is excellent but I was given the referral to Mayo from that neuro so I can confirm my rare diagnosis. I was told that TriWest prefers I go to the closest provider in order to be covered and when I venture out of network, that's when I have to pay. Even with the Mayo Clinic in Arizona being the closest facility to properly diagnose my condition, the visit will not be covered?
Jolyn> Correct I am showing it was approved as Point of Service.
Sarah26> I don't intend to keep going to Mayo, I just need to confirm what my neuro in my area thinks I have. And with it being quite serious, I want the best. I'm just trying to see if there's anyway to get it covered.
Sarah26> So are you telling me that it's Point of Service and there's no way that's going to change?
Jolyn> Your doctor can write a letter stating there is no one else that you can be referred to in your area concerning this.
Sarah26> Ok. Thank you.
Jolyn> If there is no one else that takes care of this it may get overturned.
Sarah26> Got it!
Jolyn> Is there anything else I can help you with?
Sarah26> One last question, if my neuro writes the letter stating that there is no one else he can refer me to in my area, can that letter be sent to me and I forward it to you guys or does it need to come directly from him?
Sarah26> I know it needs to be on his letter head and all that, I'm just thinking it'll get to you guys quicker if I go up there and have him do it in front of me and then send myself.
Jolyn> I would have them fax it to us. along with referencing the referral number that is already in the system.
Sarah26> Got it!
Sarah26> Thank you for your time.

So there you have it. I have already contacted my neuros nurse and left a message for her regarding my new dilemma. Now I get to wait on them again. Great! They're going to need to perform this duty a bit more swiftly than the last. If they shoot the shit for too long, I'm going to end up needing an updated referral. I hope that doesn't happen.

3 comments:

Sarah said...

I think writing these blog posts are giving me good luck. When I wrote about not having my referral, I get my referral. When I wrote about this and leaving a message with Mary (Neuro's Assistant), Mary calls me back. One the same day!! Unbelieveable. They must know I won't quit. =)

So, the bad news. My neuro is on vacation until the 20th of August. She's going to see if the NP in the office can write the letter the insurance company needs to hopefully cover the cost. If so, that should be done tomorrow evening sometime. Either way, she said she'd call me back and let me know.

Fingers crossed.

Yvette said...

Did you ever get to Mayo Clinic? I also have NMO and was curious to know if it's worth a trip to see Wingerchuck. They don't take my insurance, so I'd have to pay out of pocket.

Thanks,
Yvette

Sarah said...

Hey Yvette,

No, I'm not goint to be going to the Mayo Clinic. My insurance approved my visit there but I would of had to pay a $300 deductible plus 50% of all charges. I had no idea how high that bill could get and I wasn't willing to pay 50% of God knows what.

I did however get approved to see Dr. Cree in San Francisco and he is very familiar with NMO. I also spoke with Dr. Wingerchuk face-to-face at the NMO Patient Day last Wednesday and he told me that they are more than willing to correspond with our doctors close to home and suggest treatment options for patients with NMO.

I think the hard part about that is finding a Neuro who's willing to acknowlegde that he/she doesn't know much about NMO (if they truly don't) and is willing to speak with someone who does about your case.

If I could afford to pay for everything, I would. But I'm completely comfortable with Dr. Cree who's familiar with the disease and even sees some patients I know.

Where do you live?