Wednesday, April 15, 2009

T stands for TICKED!

Today has sucked. I woke up feeling all down and sad and just plain out of sorts. I have tried all day to get out of the funk and to not let Tom see it, because there is not a damned thing he can do, and he has enough to deal with right now.

I did some grocery shopping and got the mail. Then my day really went down the drain. Seems our insurance company.....you know, the ONE I WORK FOR!!!!! Has denied the claim for the wound VAC. Saying not enough info was given to show that this was the best option over traditional wound care!!

I called the number on the denial letter and got some chick who has never HEARD of customer service. I don't even think she can PRONOUNCE "COMPASSION". Needless to say, less than willing to assist or even CARE.

I have called the surgeon's office (voicemail message left). I have called our Bariatric Case Mgr. (she is on LOA and I left a voicemail msg with her partner). Tom has called the home health company, you know...the one who gave the information for the DAMNED APPROVAL (she will call us back, she is in a meeting). I have emailed a co-worker who is the head of the Bariatric Case Mgt team (will probably hear in a day or 2 from her... she IS busy).

Tom is trying to keep me calm and Sue is saying "Don't worry, we'll pay for the damned thing if they won't!"

But, dammit, that is not good enough. It is not right. This is the company I work for. Someone should care. Someone should help. And someone should have known BEFORE SENDING The VAC that it was Approved.

Tom is greatly improved because of the VAC. Today, the smaller of the wounds is about 30% of the original size. The larger wound about 50% of the original size......after 6 days!!!! We would be doing the wet/dry packing and bandaging for approximately 8 weeks..... now we might be looking at 3-4 weeks. For that 8 weeks, the insurance company would have to pay for supplies, medications, and a nurse 3 times a week. With the VAC, it is rental of the Unit, medications and a nurse 3 times a week FOR 3-4 WEEKS!!!! Which seems more cost-effective to you??? Yep, that is what I thought.

I am done today. Last night I started a post and deleted it because I felt like I was being a big whine-baby. Well, I am still a whine-baby.....but a pissed off one, at that!

T

5pm update:

We have received calls back from the wound VAC rental company (they will assist with an appeal, if needed. And they cannot understand why it was denied since this Insurance company approves them ALL THE TIME!), and our surgeon's office (who started with "Teresa,honey, calm down. We WILL get this taken care of. It just might take some time, but we will do whatever necessary to get this resolved for you!")

Ok.....I am calmer and more confident that this will be resolved appropriately now that we have people on-board with us to do the work......now where is my migraine medication???

5 comments:

Tapestry said...

I'm sorry to hear about the red-tape and bureaucratic nonsense. I suspect it's even more infuriating for you since this is the company you work for.

I also wonder if a little bit of "piss and vinegar" (to quote my grandmother) is actually good for you. Obviously I don't mean that you should be so upset that it sets you back or has a negative impact on your health, but something like this can give you a purpose and determination, something to focus on which might be good for you right now. Maybe not, it's just my little mind a-whirring...

In any event I hope it's all worked out soon, and obviously I hope for the more cost effective and more intelligent outcome!

hugggggg
Tapestry

M:e said...

I can just imagine your frustration over this. I hope it gets sorted out soon.

love and hugs xxx

Amber said...

I hope this all works out, gah, so frustrating!

Anonymous said...

Hello? Where did you all go? Is everything ok? Just concerned since its been 4 days since any new posts were added. Hope all are doing well.
Concerned

Amber said...

I'm a little concerned as well, if one of you could check in, even very briefly, that would be great! :)