I recently had a changeover in my insurance where my COBRA ended and I had the option to private pay. The cost is pretty high, over $450.00 a month, but for continuity and because I have so much going on healthwise with so many doctors, Grant and I decided I would continue with my insurance. It’s the same insurance and I was told the transition on October 1st would be “seamless”. The biggest issue I worried about was the Orencia infusion for my Lupus, which is supposed to be given every four weeks. Due to no doctors being available (I wasn’t told why) I could not get Orencia when it I was supposed to so I got scheduled for October 5th instead of the prior week.
I’m all paid up with the insurance, I have my new card, and I get a call from my Rheumatologist’s office saying that they cannot even ask for permission for me to get Orencia until October 1st. Even though I am already paid for October and it is the same insurance! My Rheumatologist then tells me on October 1st that I need a referral for them to even ask if I can get my Orencia, even though I don’t have an appointment. How can I make an appointment if I don’t have approval for Orencia?!
On October 2nd I ask the staff of my Primary Care Physician to date my referral for that day. I let my Rheumatologist’s office know and they say they will call me if there is a problem. They have to reschedule for October 12th and now I have the added worry that I will go out of remission. So, here is what really pisses me off. My Rheumatologist’s office calls me on Wednesday, October 7th saying there is no referral. They are mad, saying they have been trying to “jump on this”. Ummm, jumping on this means checking on Monday NOT Wednesday, when my appointment is the following Monday! It turns out I have a referral but it is not for the doctor who gives me my infusion. They have never told me I needed a referral for that doctor, EVER, I’ve been seeing them for over a year! How did he give me my infusions before? I ask them does this mean I won’t have my infusion October 12th and they say, “We’ll let you know if there’s a problem”, not very nicely. On Friday they tell me I will not be able to get the infusion and they have optimistically scheduled for October 15th (today). They tell me that they will call if there is a problem and that they will call to confirm as usual two days prior.
So on Tuesday they call and confirm. I say, “Great, so everything’s been approved”? The staff member tells me yes. I call AGAIN today to confirm my appointment. No problem. I come in today, Grant has dropped me off. Even though I want to wring their necks I thank them for all their hard work. The woman at the front desk says, “Wellll, we still don’t have the approval yet”. At this point I am trying not to scream. Why am I in this office?! Why did they tell me to come in?! Two people are telling me how many calls they made. That’s great, but why did you tell me to come in today? I think it was more like, “Oh, shit, she’s coming in today and we never got the approval”! The woman at the front desk makes another call and LUCKILY gets the woman at the insurance company who says it has been approved. Of course if she never got in touch with her I would have gone there for NOTHING.
I am so angry at the insurance company and the doctors’ staff. They are all annoyed, but I am the patient. I’m the one who had to make the calls AND worry that if I didn’t get my infusion in time, that I could come out of remission. No one in this situation was more upset than ME! But they don’t get that. So, I got my infusion and now I just have to hope that it wasn’t too late.