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Old 19th January 2010, 3:21 PM   #1
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How to handle situation with doctor's office

There is nothing scandalous or anything, but I'd like insight on how people might handle this situation.

LONG STORY SHORT - because the office staff dragged their feet, and despite my repeated calls in an effort to prod them, this situation could cost me $300+ when it likely would have been covered in full had they done their jobs and gotten me in before the end of the year. (Details at the end if you REALLY want to know them)

I was advised to speak to the doctor DIRECTLY about this issue, to see if because his staff dropped the ball, he would be willing to work with me on it. I called the office and told the receptionist that I wanted to speak with the doctor and gave my name and number. She asked for a message, I said it was a personal matter. She seemed confused but said she would pass it on. Within 2 minutes the office manager calls and asks if there's anything SHE can help me with. I said no, there wasn't. She said well i really need to be able to tell the doctor what this is regarding. I said it was a personal issue I wanted to discuss with HIM, thank you though. She said well if you don't tell me what it's about,... well... it could take him a while to get back to you. I said I'll wait for his call then.

I was told by someone else who had experience working at a doctor's office that it is perfectly reasonable for doctors to wait until after office hours to return non-emergency calls and that if I didn't get a call back today that I should call back in the morning and leave another message.

How would YOU handle this? I am not a screamer, but I have no trouble being firm. I just have a feeling this office manager is filtering people like me away and I refuse to discuss my problem with her WITH her.


The details:

In Nov of '08 I had a Paragard IUD implanted by Planned Parenthood. The side effects are a bit annoying (several days of PMS and then anywhere from 9-13 days of actual period), but I have been living with them and in all other respects find the IUD a great birth control method for me. At the time of the implant, I paid nothing out of pocket for it, simply my co-pay.

Fast forward one year - I had an issue that I went to see Planned Parenthood about. I was certain they misdiagnosed it and went to a former OBGYN about it. I had seen him YEARS before (like close to 10), and I always really liked him, very nice fellow. When I saw him (late November '09) he said he would get back to me pronto about the issue I was there for (since I was so concerned), and also suggested I switch to the Mirena IUD, which would reduce my side effects significantly. The office staff told me it would take about 2 weeks for the insurance company to get back to them about coverage on it.

I waited patiently, then began calling to follow up about my test results. It took about 4 calls before I finally was called back and given the ok and the actual results. Prior responses were "if you don't hear form us, everything is ok" which I do not accept, particularly since I was so concerned about a misdiagnosis.

Around the two week mark I called regarding the insurance coverage. Was told to give it a little more time. I continued to call throughout December, and was responded to with "we'll call you when we hear from them..."

Last Friday, the 15th, I'd had it and told the receptionist that my insurance was likely changing at the end of the month and I would REALLY APPRECIATE IT if someone would call the insurance company and follow up on this. I apparently got the nice girl, who called right away and told me she had placed the call and promised to call me on Monday regarding it.

Yesterday she called and said that she is still waiting to hear back regarding 2010 benefits, but normally they do not change and my 2009 benefits were $100 deductible and I would need to pay 10% out of pocket (about $160 total). Also said there was something messed up with the fax form the insurance company which is why they never called me. When I expressed confusion because I hadn't paid anything for the other one, she suggested I call my company and get an explanation.

I call today and was informed that actually 2010 benefits DID change to a $250 deductible, and that the reason I paid nothing out of pocket in Nov '08 was because I had already paid my deductible down, it being the end of the year and all.
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Old 19th January 2010, 3:23 PM   #2
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can you go to the office in person?
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‎"I am willing to move out of my comfort zone and experience life in a new way." ~ Louise L. Hay
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Old 19th January 2010, 3:41 PM   #3
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I'm not entirely sure what/when the services rendered were.

If you were treated during 2009, and that's when all the bills are from, then your 2009 insurance coverage has to apply. It doesn't matter that your insurance is different now, services received in 2009 fall under your 2009 coverage and whatever deductible/plan you had then. If you hadn't met your deductible, you owe that plus whatever is not paid by the plan.

If your problem is that you are now trying to get the new IUD, you're out of luck and there isn't anything the doctor's office can do. They can't back-date services or whatever - that's not legal. Your 2010 coverage applies starting Jan 1 or whenever the new plan takes effect.

If you need answers from your insurance company about coverage, you should always call yourself if you really need to know under a specific timeframe.
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Old 19th January 2010, 3:55 PM   #4
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good question

In short if his staff had done their jobs you could have gotten this done last year for much much less then this year. And it looks like they dropped the ball again and again.

I think it is fair to ask the office manager if the doctor has a private email address that you could send a message to. And then I would tweak the message below - like I would not say dragged their feet - but I would say that they failed to verify the insurance for a period of X weeks despite Y calls from you explaining why it was time sensitive.

I do think it is fair that you ask him to give you a better price on this - his people really did jerk you around.

This ALMOST happened to me once. Pretty similar situation - but 1,500 dollars at risk. Very stressful.


Quote:
Originally Posted by KikiW View Post
There is nothing scandalous or anything, but I'd like insight on how people might handle this situation.

LONG STORY SHORT - because the office staff dragged their feet, and despite my repeated calls in an effort to prod them, this situation could cost me $300+ when it likely would have been covered in full had they done their jobs and gotten me in before the end of the year. (Details at the end if you REALLY want to know them)

I was advised to speak to the doctor DIRECTLY about this issue, to see if because his staff dropped the ball, he would be willing to work with me on it. I called the office and told the receptionist that I wanted to speak with the doctor and gave my name and number. She asked for a message, I said it was a personal matter. She seemed confused but said she would pass it on. Within 2 minutes the office manager calls and asks if there's anything SHE can help me with. I said no, there wasn't. She said well i really need to be able to tell the doctor what this is regarding. I said it was a personal issue I wanted to discuss with HIM, thank you though. She said well if you don't tell me what it's about,... well... it could take him a while to get back to you. I said I'll wait for his call then.

I was told by someone else who had experience working at a doctor's office that it is perfectly reasonable for doctors to wait until after office hours to return non-emergency calls and that if I didn't get a call back today that I should call back in the morning and leave another message.

How would YOU handle this? I am not a screamer, but I have no trouble being firm. I just have a feeling this office manager is filtering people like me away and I refuse to discuss my problem with her WITH her.


The details:

In Nov of '08 I had a Paragard IUD implanted by Planned Parenthood. The side effects are a bit annoying (several days of PMS and then anywhere from 9-13 days of actual period), but I have been living with them and in all other respects find the IUD a great birth control method for me. At the time of the implant, I paid nothing out of pocket for it, simply my co-pay.

Fast forward one year - I had an issue that I went to see Planned Parenthood about. I was certain they misdiagnosed it and went to a former OBGYN about it. I had seen him YEARS before (like close to 10), and I always really liked him, very nice fellow. When I saw him (late November '09) he said he would get back to me pronto about the issue I was there for (since I was so concerned), and also suggested I switch to the Mirena IUD, which would reduce my side effects significantly. The office staff told me it would take about 2 weeks for the insurance company to get back to them about coverage on it.

I waited patiently, then began calling to follow up about my test results. It took about 4 calls before I finally was called back and given the ok and the actual results. Prior responses were "if you don't hear form us, everything is ok" which I do not accept, particularly since I was so concerned about a misdiagnosis.

Around the two week mark I called regarding the insurance coverage. Was told to give it a little more time. I continued to call throughout December, and was responded to with "we'll call you when we hear from them..."

Last Friday, the 15th, I'd had it and told the receptionist that my insurance was likely changing at the end of the month and I would REALLY APPRECIATE IT if someone would call the insurance company and follow up on this. I apparently got the nice girl, who called right away and told me she had placed the call and promised to call me on Monday regarding it.

Yesterday she called and said that she is still waiting to hear back regarding 2010 benefits, but normally they do not change and my 2009 benefits were $100 deductible and I would need to pay 10% out of pocket (about $160 total). Also said there was something messed up with the fax form the insurance company which is why they never called me. When I expressed confusion because I hadn't paid anything for the other one, she suggested I call my company and get an explanation.

I call today and was informed that actually 2010 benefits DID change to a $250 deductible, and that the reason I paid nothing out of pocket in Nov '08 was because I had already paid my deductible down, it being the end of the year and all.
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Old 19th January 2010, 5:32 PM   #5
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Yes, I can show up in person, but I am not sure I want to.

The services weren't rendered in 2009, but could have been if they had stayed on top of things.

Grrr. I think I just need to switch to someone who's staff gives a damn when I call.
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Old 21st January 2010, 2:48 PM   #6
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Still haven't spoken with the doctor - I missed his call when his office called me during dinner with my family (sorry, not having that conversation during dinner). The message left by the office manager was that the doctor is not in on Wednesdays and they would try and reach me again Thursday (today). No call yet, but I would expect the call after office hours anyway.

I DID call my insurance co just to check and see if they had any record of the office contacting them. Was told they received no forms from them, though they may have verbally contacted and they likely would not have noted it since they get so many calls from medical professionals. The rep did check all areas to make sure no forms came in at all. He also told me that the IUD did NOT require an authorization - they could have simply called to verify coverage and scheduled the appointment immediately.

That's what really rankles my fur. I call repeatedly to get a status, and everyone there is too lazy to pick up the damn phone and check on it, instead telling me "don't call us, we'll call you when we hear back from InsureCo.". GRRR.

Just venting.
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Old 21st January 2010, 2:53 PM   #7
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Quote:
I think I just need to switch to someone who's staff gives a damn when I call.
Having fired many doctors as a care manager, I think this is a healthy perspective. They're providing a product and service. If that product or service is unsatisfactory, or if the 'fit' isn't healthy, try another practitioner. There are tons out there.
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Old 21st January 2010, 10:44 PM   #8
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And when you sent a letter to both the Doctors office and the Insurance Company, what was the response? As the holder of the insurance its YOUR duty ultimately to pay all fees. 99.9 % of any Doctor I have visited whether I had insurance or not clearly states that the patient is responsible for all financials and they will ACT on your behalf to work with the Insurance Company- BUT Ultimately you are responsible for checking up on things as well. Any decent lawyer would tell you the first rule of thumb is to GET IT IN WRITING.
They are doing you a favor by processing the paperwork. Not to be harsh, its just that so few folks get the FACTS straight before jumping to the conclusion that it MUST be the Insurance companies fault or someone elses before seeing where they may have errored. ( Yes I have done this so I do understand)
The Doctor is NOT the Key to this issue, a pen , paper, and a papertrail (copies if need be of the medical fees) are. He isnt an accountant or insurance agent...He administered medical care and diagnosis...
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Old 21st January 2010, 11:09 PM   #9
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He administered medical care and diagnosis...
Indeed, and he is also responsible for the actions and perspectives of those in his employ. He's the boss, if he's in private practice; if not, there's a corporate manager who's responsible. The OP's beef is primarily with staff being unresponsive. The buck stops with the boss, whoever that is. When I was reading, I saw, with years of business experience, the classic boss-block, where employees who make mistakes block access to the person who would hold them accountable. I've had plenty of employees po'd at myself, both as a care manager and boss. Goes with the territory.

As I said, if it's a bad fit, move on. No prejudice. Life goes on
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Old 22nd January 2010, 8:15 AM   #10
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@Tayla - When I fill out paperwork at the staff's request and the staff accepts the responsibility of doing to following up, I simply expect them to do what they say they will do. I understand things can fall through the cracks - happens all the time. But that's why *I* called to follow up with them - REPEATEDLY. In doing so, I gave them plenty of opportunities to get on it and was repeatedly told to just wait for them to call me back. I am not experienced in how medical personnel deal with insurance companies - whether they need special forms or secret handshakes or whatever to get things done, so I trusted that they would get off their duffs and make a freakin call, particularly since I was being a squeaky wheel. The problem I have is that I was completely ignored until I told them I was potentially LOSING my insurance coverage. THEN they got cranking and - lo and behold - realized they effed up and are now trying to block me from speaking with the boss about it. And yes, the doctor wasn't the one who directly effed up, but he IS the boss and I want to make damn sure he knows exactly what happened, so when he never sees me again, he knows it's because his staff handled things incredibly poorly.

PS: How surprised is everyone that I never received a call yesterday. I'll be on that this morning.
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