Sunday, September 6, 2015

Stick To Your Word, That's All I Ask


     So Friday, on my personal Facebook account I posted a single line and a photo that pretty much says it all to how I was feeling.  I am a simple person that has his own faults and understands simple mistakes are made in life, but as a person who has spent the better part of his working life in the retail customer service industry, I know how important your word  is to a customer.  You break that word and not only do you lose a customer, but your credibility is lost with future customers as well.  When other companies do this to me, it pisses me off!  Why a person or, a company in this case, can't or won't at least do the fucking minimum requirements of a job that would provide basic level quality customer service I'll never know.  It all comes down to the fact that if you say your going to do something than fucking do it.  Don't say you will and then weeks later take it back and wait till the last possible second to tell the customer, leaving him or her stranded with no recourse.  That is at the heart of what my Facebook post was all about.

      So here, let me give you a little insight into what I have been dealing with since late Friday afternoon.  Everything in my day was going well until Mandy opened a letter that came in the mail from the insurance company basically stating that my surgery is not being covered. That's right, 6 days before surgery they decided to tell me it wasn't covered, and better yet, when I called my doctor's office about it, the scheduling nurse said she had no idea it wasn't covered. She told me that when she submitted the codes for surgery to them they pre-approved everything and we were good to go, or so she thought.  After talking with her I called the insurance company and after several minutes of looking things up and reading all the notes on my case file she told me that everything was good to go. Wait, what?   She stated that the doctor's office submitted one code and it was denied, so they resubmitted a new code which was approved, so that is what the letter was all about.  Which is weird because the nurse I spoke with had no idea that anything was denied and was under the impression that we were good to go, but ok great, so we are good to go then right? I said.  Yes sir, she says.  She reiterate that everything was covered and after my deductible was met.

     Five minutes later is when it all changed.  The lady I spoke with from the insurance company called back to says that she miss read the notes and that my surgery wasn't actually covered. Her reasoning was that my doctor had submitted two procedure codes and the actual surgical procedure code was denied because I have not spent 6 fucking months resting from all sports related activities, sought alternative treatments options and medication to treat the tear in my cartilage.  I am by no means a doctor, but within 10 minutes of research on the internet told me what I would imagine every first year med student would know that cartilage doesn't repair itself.   What it sounded like to me is the insurance doctor that reviewed my case seems to think that those other options are viable options to solve my issue and my doctor should have prescribed these first.  So some guy or girl that probably got all D's in med school, barely made it through their residency, couldn't find a real job, probably never practiced medicine and takes home a large paycheck from the insurance company because his job is to save them money not treat the patient.  Yes I am pissed if you can't tell.  Needless to say I blew a fucking gasket and almost tore my office apart at work.

     Where does it all go from here?  Tuesday the nurse is going to call the insurance company and try to get it covered, and if she can't she will request a peer to peer review with my doctor and the insurance company doctor.  Thanks to the timing of the letter arriving on the Friday of a holiday weekend, Tuesday is the earliest they can work on this and I may not know till the end of the day Wednesday whether or not I will be going in for the procedure Thursday morning. 

     I have just had enough with all the bureaucratic bullshit.  When I had my MRI done, it was pre-approved as well for a certain dollar amount, but when I got the bill the insurance decided not to cover as much as they said they would and I ended up having to pay an additional $500 fucking dollars. If you say your gonna cover something then just stick to your word, I am just tired of it already.  The only reason I didn't completely blow a gasket on that whole deal was because I knew I was having surgery at that point and I would have had to pay it to cover my deductible, whether it was now or later.

     Anyway, sorry for the long rant, but that is what has been going on the last couple of days.  I just needed to blow off some steam and writing about it here seemed to help.  Lord knows I can't run right now to burn off this negative energy so I had to do something.  Enjoy your holiday weekend!


  1. I'm so sorry your insurance company is doing that to you. I hope your doctor goes to bat and gets it all sorted for you this week!

  2. Wow. What the actual fuck. Any idiot who can use Google would be able to tell you your diagnosis meant you'd have to have surgery. It's ridiculous that you have to go through this.

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  4. I'm sorry you're dealing with this BS. This is the thing that pisses me off the most about insurance companies - they do this to you when you're vulnerable, i. e. injured or sick. It's disgraceful the way they treat their customers.

  5. Insurance companies are a racket. I wish we'd get rid of them altogether. Ridiculous.