Friday, September 07, 2007

I hate my HMO!!

I hate my HMO! HATE THEM! After our visit to the peri yesterday, we were supposed to schedule our next appointment for the in depth ultrasound and possible SR. Well, they wouldn't schedule it because they needed authorization. UGH. Did my RE office ever do that? NO! They just scheduled me then got authorization. Anyway, I did what they said and called my OB to let him know they would be calling for authorization, and he knew what for as well. The peri office never called me today, so I called them. The receptionist tells me I still need authorization. I tell her it is super important I get an appointment because it HAS to be done in a certain time frame. She transfers me to their billing department. This lady says it takes 3 days. UGH. But then luckily she looks me up and an authorization has gone through. However, it is the WRONG authorization. It is for a consult!! So, I totally blame whoever called from the peri office, because they should have known! So, I call my OB and of course he isn't in. I leave a message. Luckily I got someone who seemed competent. Sometimes I don't and they mess up the messages. I made sure she put on there that this was URGENT.

Why can't they just schedule me?!?!? It makes no sense! I HATE HMOS! And why was *I* doing all the leg work? I wish all offices were like my RE office. They always got all authorizations and everything. They were great. I guess that's how it works when many of the patients pay out of pocket. I'm just so mad. I really don't need this stress on top of everything else.

I also wanted to address some of Karen's comments. Thank you for the info! I know my peri said he'd done 50 reductions, and has had 1 loss. He is sure the loss was from the reduction because the loss happened the next day. It bothers me a bit that he said he has done 50. Of course, I didn't think to ask if it was 50 total, or 50 a year. I have a feeling I will be calling him back to talk to him some more.


Natalie said...

UGH!!!! What a pain in the ass!!! I hear you.... my RE's office handled everything insurance-wise, I never had to do anything. And this is in MA, where almost everyone has insurance coverage. I don't understand why doctors offices don't do the same thing... who is better at dealing with insurance, them, who does it all the time, or you, who does it once? GAH.

I can't believe they're putting all this onto you. :( And like you said, you can't just sit around waiting!!!! I am just SO mad for you!

Fertilize Me said...

Heather - Gosh. what a nightmare. Still sending my prayers ( ill say thme louder so maybe they are heard this time)

Sara said...

Heather- I am sorry they are being a pain in the ass...the insurance, the office, everyone. Hang in there- keeping you in my thoughts.

Egged Out said...

Oh - what a drag to be dealing with HMOs and authorizations when you need to focus on getting information and quality care and making decisions. I think we go to the same RE and I have found them to be great at dealing with insurance and calling back - I just figured it was because most of us are paying out of pocket (for all or part of the services) and we have choices so they have to provide good customer service. There are several other fertility clinics in our city. I know I will miss them IF I ever move on to an OB/Gyn. My husbands loves their coffee machine. Sorry about your troubles - people should be smoothing the path for you so you can get into see doctors asap. Take care, Egged

Karen said...

argh, how frustrating. HMOs are great for a lot of reasons, but sometimes the bureaucracy is utterly ridiculous. I am grateful to have a PPO, because I'm not sure I could handle the stress of this pregnancy and the bureaucracy of an HMO at the same time.

What we did after our initial consult with the RE was schedule the nuchal fold ultrasound and CVS and also the SR appointment for a week after that. We decided that if the nuchal fold had any red flags, we'd do the CVS testing, and that if anything came out of the CVS testing that swayed us one way or another, we'd keep the SR appointment. As it happened, we didn't even end up doing the CVS, because the nuchal folds were all exactly middle-of-the-range of perfect.

That being said, as I've told you before, we were using very different criteria for our decision-making process than a lot of people use.

I'm guessing with a number like that, the peri was saying he's done 50 total reductions. So the only thing I'd want to know is over what period of time? Either way, though, that's a pretty respectable number, so you can see that he's got a fair bit of experience with a pretty good track record in terms of total fetal loss. (Also was that loss that he had a triplet to twin reduction, or was it even higher order multiples? The risk goes up with the number you start with) Why does it bother you that he's done 50 reductions? On the one hand, it's sad that 50 people have faced a need even consider the issue, let alone walk down that path. However, you obviously don't want to be a perinatologists' 4th or 5th reduction either.

I wish you much luck and much peace in the coming couple of weeks, and I hope that the insurance stuff works itself out quickly. I'm thinking of you.

Anonymous said...

I'm praying for you and your three little ones.