Pre-authorization - help me understand!

[MOOBM]

@John58

silver lining was I documented the whole mess with good notes and used them to make the case that due to mis management of the vendor my insurer was unable to fulfill my orders for Dexcom supplies, stressing the word Continuous in CGM. I put my foot down with the insurer and told them they are obligated to find an alternate supplier for me.

That is great!!! I’m going to stick that one in my bag of tricks!!

[DrBB]

@John58

I would call each and (after they checked their screen and told me “It has been faxed”, “will be reviewed pronto”, etc.) ask “What number did you fax it to?” and then call the other and ask “Was it received…What number should it be faxed to?”, call the other back with the correct faxing instructions, etc.

Acting as unpaid clerical staff for giant corporations is one of my favorite things to do.

[CJ114]

@DrBB

Acting as unpaid clerical staff for giant corporations is one of my favorite things to do.

Ya, they couldn’t afford us if they had to pay us to do it right so looks like pro-bono is the only way.

[Vtfishgirl1]

Hello, i would go directly to your HR department if you can’t contact the insurance company, which is ludicrous by the way. Way to get you into a run around phone calling nightmare. I’ve been in healthcare my entire career as an advocate, answering for Medicaid, Medicare, managed care and private insurance policies. It all comes down to the plan’s coverage your employer has chosen. They switched carriers for a reason and you may have stumbled upon than reason. I would ask directly has pre-authorization process changed, is their a new list of formulary drugs and have they restricted coverage for a group of drugs, yours specifically. Do they want a healthy employee or one stressing over their coverage having to go back and forth between doctors, HR and/or pharmacy staff to get answers about their coverage. If you get no resolve, I would call your State’s banking and insurance office or healthcare ombudsman to get help navigating. Bottom line you are entitled to know your covered benefits. Best of luck to you.

Ps have you checked here?
https://dexcom.pskw.com/

[mohe0001]

Its always been my dream to hire some kinda secretary to do this. I don’t know if such a profession exists, or who you would hire to do it. It would need to be some type of terrible monster animal built out of pieces of other animals in hell. Might, ideally, be half a lawyer, half a nurse, part medical billing specialist. Might look like this.

I am interviewing for the position of “Medical Chupacabra”. Desired experience listed below.

Chupacabra

[MOOBM]

@mohe0001

Its always been my dream to hire some kinda secretary to do this.

That’s so funny because I have always wished I could help more people through this…What really made me laugh was your “ideal Medical Chupacabra”. I am a paralegal by training; did medical billing (back when 1 person did the whole process and not like today where you have 7 people to a single step of the process); and, though I’m not a nurse, I can pass the practice nursing tests online (the Endocrine portion) (I take them for fun to test my knowledge level).

[Kyn72]

You have my sympathies as it sounds like the insurance nightmare I just went through getting my pump supplies this month from the supplier in Florida.

[mohe0001]

HIRED! You are the great chupacabra! You hold the answers we seek.

[Sally7]

I agree. I work for a large company, so when things get bogged down, I call HR. And if I have to push it up the ladder, I get a response pretty quickly.
The joys of insurance☹️