Thursday, May 21, 2009

Appointments, appointments, appointments...

Today was my big day of appointments. In the morning I saw my dermatologist for a whole body exam. After lunch I had my hair cut into a short pixie style again so it'll be more manageable once it starts coming out. In the afternoon, I had a dentist's appointment to make sure my teeth are in top shape so I won't need dental work during chemo. 

The first two appointments were uneventful, but the dentist's visit was quite something else. I saw this particular dentist, Dr. M, for the first time today. He seemed really competent and was really nice. I needed to have a tiny filling replaced, which he could do without lidocaine (one less needle-prick, yay!), and he cleaned my teeth.

The problem was really not with the dentist, but with our dental insurance. As it turns out, until 2007 we were in a dental HMO plan. DH saw one of the few people who accept that plan in our county, and he wasn't that good. Essentially, he refused to do any work during the session he discovered the need for it, but always made DH come back for another appointment (more money for him, I suppose). So in January 2008 we filled out the paperwork to switch to the other dental option offered by DH's employer, which is a PPO plan, since it would give us many more options.

Dr. M is in-network on the PPO plan, but not an option under the HMO one. So when he tried to verify my eligibility, neither DH nor I showed up. After a frantic call to DH, and some soul searching, I asked him to check eligibility under the HMO plan, and lo and behold, we were still eligible under that -- except Dr. M is NOT a participating provider. An urgent call from DH to his human resource department spurred them to find the paperwork we had given them back in '08. However, the PPO dental insurance claims they never received the paperwork. Arrrrrgh!!! Why do they keep messing up like this? I guess we would have found out sooner, if we had been going to the dentist more often, but still, this is ridiculous. 

The upshot of the whole story was that I had to pay for everything up front. However, Dr. M was kind enough to say that he would submit a claim if it turns out that I was eligible for the PPO after all, and then reimburse me. In 48 hours we should be on the computer system, and since they backdated our eligibility to May 1, we should be covered for today's work. Still, yet another pain in the neck!

I am getting pretty tired of insurance companies. Due to the vagaries of our particular plan, we have FIVE different insurance cards: one for doctors, one for hospitals, one for regular medications, one for special medications (injectables, asthma, chemo, etc.), and one for dental. It's a science to figure out who covers what. Frankly, most of the time it makes my head spin...!

For instance, when they refused to pay for the surgeons for my mastectomy, since I had a lumpectomy with reconstruction a month earlier. They consider this "follow-up care" for which they do not allow extra charges. So now I might get stuck paying approximately $40,000 in surgeons' fees. If they insist on refusing to pay, I'll grieve it. I'll fight them big time -- what's wrong with these people?!

So to calm down after all this running from appointment to appointment, I found myself some candles for my chemenorah. It's a very multicultural chemenorah now, since the candles are Chinese Buddhist ones. But with a pencil sharpener they fit into the chemenorah quite nicely. Plus, I thought their pretty red color was very representative of the adriamycin, the "red devil" they will start pumping into my body soon. So the chemenorah is all set up now, and ready to go. Watch out chemo, here I come.

But before then, I have a nice long holiday weekend to enjoy.  Time for some more normalcy first: some gardening, some walks with the dog, time with DH, time to relax. I'm looking forward to all of that.

1 comment:

2L said...

STOMP STOMP STOMP on those insurance companies!! STOMP STOMP STOMP