Here a Code, There a Code!

And yes, I am ready for the funny farm.

It is National Invisible Illness Awareness Week, so this is perfect timing.  For all of you healthy people who never have to go to the doctor, or who don't ever meet your deductible, or don't even know what a co-pay is, this is for you.

Got a bill from my doctor for my annual exam saying my secondary insurance didn't cover it because it wasn't medically necessary. (The same exam that they harp on you until you get it....send emails, phone calls, rent billboards, whatever...)  So I call Priority to find out why they denied the claim.
Me: Hi, I have a question about a claim that was denied.
Pri:  Date of service? blah blah blah
Me: gave them info.  This was for my (I'll spare the details for the dudes).  Why was this deemed medically unnecessary?
Pri:  It wouldn't be.
Me {Sigh...here we go}: Um, I have a bill for $**.** and a notation saying Priority Health said "exam not covered Not Medical Necessity", yet on my Priority website it says I'm due for said exam.
Pri: Claim number?
Me: blah blah blah
Pri:  Oh, I see.  They didn't bill a procedure code.  We can't approve it without a procedure code.  We don't know what you had done without a procedure code.  Blah blah blah procedure code.
Me: What EXACTLY has to happen for you to approve this claim?
Pri:  They have to resubmit it.
Me:  Is there a specific fax number or something?
Pri: No, they do it electronically.
Me:  Gotcha.
Click.

So I call the local doctor's billing people.
Me:  Hi, I had a claim denied because there was no procedure code on it.
Them:  That's not possible.
Me {SERIOUSLY????}:  Um, I have the bill in front of me and it says, "Routine Phys Exam Not Cover Not Medical Necessity."  And I called Priority and they said they had no procedure code.
Them:  Well they're wrong.  We can't send it without a procedure code.
Me {hitting myself in the head with a hammer hoping to just pass out}:  Well, do you think you could resend it since they claim they don't have it?
Them:  Well, I can resend it, but they should have it.
Me:  Well obviously I can't tell you if that is true or not because I don't have the paperwork in front of me.
Them:  Well, like I said, I'll resend it.
Me {thinking, oh, how mighty kind and generous of you....I owe you my first born...} Thanks.

That was AFTER I was on the phone making SEVEN different appointments.

Ah, yes.  A day in the life.  By the time I make Jacob breakfast and lunch, try to remember to eat something myself (which usually happens in the afternoon when my blood sugar crashes), AND if I have a day like this when I have to straighten out some idiot's mistake, do all my medical crap (shake-alator, breathing treatments, clean trach, etc.) I'm not sure I have time to clean my house, fold laundry, take care of the dogs, get dressed, get Jacob dressed, homeschool, work on jewelry, and cook.

Just sayin'.

Just ONE Thing We Deal With

{The back story for this post is that after THREE years, Medicare keeps sending my claims to BCBS even though I don't have that insurance any longer.  Someone from Medicare told me I had to have BCBS send Medicare a termination of coverage letter (which I've already done twice)....that's how this all began. Oh, and I should mention I tried to call first, but the wait time was over 10 minutes, so I thought I'd try this...SILLY ME!}

Okay, this is the actual conversation I had with a "live agent" on mymedicare.gov website.

Thank you for contacting MyMedicare.gov Live Chat.

KERRI:  I need the mailing address to send a termination of benefits letter from BCBS (for the second or third time).

Please wait while you are connected to an agent.
You are now connected with MyMedicare.gov Live Chat.

Thank you for contacting MyMedicare.gov Live Chat.  My name is Karen.  Can you please verify your first and last name?

KERRI:  Kerri Sweeris.

Karen:  Thank you Mrs. Sweeri. (Um, ya, Sweeri??)

KERRI:  Are you still there? (three minutes had elapsed)

Karen:  If you cancel supplemental policies, you need to call the supplemental company that you are cancelling and tell them to cancel the crossover. {OH my WORD I have done this a dozen times already}  Medicare cannot cancel crossover files.  Please allow 60 calendar days for the process to be completed.  If it has been more than 60 days {It's been 3 YEARS, "Karen"}, please contact your supplemental insurance company.

KERRI:  I DID call them and tell them to cancel the crossover. But Medicare told me I also needed to send a letter TO Medicare FROM BCBS, which I have in my possession, to complete the process.  I've done this like 3 times, and Medicare keeps billing BCBS.

KERRI:  I have not had BCBS for like 3 years. {I say "like" a lot!}

Karen:  I am sorry.  Medicare cannot cancel crossover files.  You do not need to send them a letter.

KERRI: {banging head against cement wall over and over}  I understand that.  Medicare requested a letter of termination of coverage from BCBS.  Again.  I already told BCBS to cancel the crossover.  I just need the address of Medicare to send the letter to. {I wanted to make sure it went to the right "department" or they would say they never got it.}

Karen:  I am very sorry.  Medicare does not have an address for these types of inquiries.
Karen:  Who told you that Medicare needs a letter? {see above for how many times I actually said "Medicare said...}

KERRI:  MEDICARE.

Karen:  Was this by phone?  {no it was by smoke signal, actually}

KERRI:  Yes.

Karen:  What phone number? {What phone number? SERIOUSLY?!?!?}

KERRI:  1-800-MEDICARE {which drives me crazy, by the way, when phone numbers are made up of too many letters....like it's really 1-800-MEDICAR.  The "E" is extemporaneous.  Makes me CRAZY!}

Karen:  I apologize.  There is no address for this.  They might have been referring to something else.

KERRI:  OH my GOSH!

And I clicked "END CHAT"

The chat session has ended.  Thank you for contacting MyMedicare.gov Live Chat.  Have a nice day.

Start time: 1:04:08 PM
End time:  1:18:52 PM

Have a nice day.  REALLY?!?!?  Now that I'm really to brutalize someone and my blood pressure is skyrocketing, yes, I shall have a nice day.

OR NOT.

Just One More Aspect of Chronic Illness

I purposely didn't post yesterday because I was in such a foul mood, and was afraid I would be posting way too many $%%$##@#! kind of words. So I refrained. : )

I have been going back and forth with the U of M over a bill for $20.86. From December 21 of last year. It would be SO much easier to just send them the stinkin' money and be done with it. But it's the principle of the thing! I can't take it. I can't just give in. Besides, if I did that every time it would add up!

So back and forth we go. They have the wrong secondary insurance. Medicare is my primary because I'm on disability. (Believe me, I'd MUCH rather be working!) and Priority is my secondary. They still have Blue Cross as my secondary; well, let me clarify. The U of M HOSPITAL billing has everything straight. The PHYSICIAN billing (which looks exactly the same bill-wise), still has is messed up. So I call Medicare (oh, what joy) and they say they need a letter from BSBC of termination of benefits so they can change it "in their system."

And HOW is this all my job? Aren't the insurance companies supposed to communicate? O, silly me...what was I thinking? That would require INTELLIGENCE and a little WORK. Heaven forbid.

So I do what they say, and it still is messed up. So I call Blue Cross again, and this time get someone who knows what they're doing {cue Hallelujah chorus} and tells me exactly what to say to Medicare to get it fixed. Because apparently at the U of M physician billing, Medicare is billed first and then sends it on to the secondary, which they still had as BCBS....just for U of M apparently.

Rabbit trail: Why the heck does everything have to billed separately anyway?? When I have plasmapheresis, a neurologist comes to my bedside (when I have the needles already in so I can't talk anyway), asks me 3 or 4 questions that take about 90 seconds, walks away, and charges $205.00. Yes, $205.00 for 90 seconds. No wonder insurance is such a nightmare!

Anyway. So I'm billed separately for their highway robbery visit. Nice.

Thankfully, the ladies at City Hall (my hubby works for the City) are willing to help me with this, because there comes a point where I'm just ready to lose it. So I e-mail the girls, and they e-mail back saying U of M is telling THEM I have a zero balance. {imagine me pulling my hair out running around the house screaming, which I can't do, but I would if I could}. So I call this morning, and I have a $20.86 balance. Someone just shoot me.

And we're supposed to have this "Employee Benefit Solutions" person to deal with all this, who has "been in this business for 20 years." However, I know more about his job than HE does! Needless to say, I don't bother with him.

NOW U of M says I need an "authorization of service" from my PCP. I'm like, you mean a referral? No. That would be too easy. "It's a little different. You need an authorization of service for that day." {more screaming and pulling of hair, maybe some poking of the eyes with sharp objects}.

So I call the PCP and they have NO IDEA what I'm talking about.

And of course, I have NOTHING better to do than spend what little energy I have dealing with all this bull$#!!.

{Sigh.}