My Doctors MA Is Frustrating Me........

Don't take the insurance company's word as gold. It is in their best interests to deny coverage or say they didn't get something that will delay the insurance company in having to let go of any money. I would believe the doctor's office - they are the ones looking out for your interests, not the insurance company.

Don't rely on the inc company telling you the truth all the time either!!! I have goen round and round with my inc company when I have sent them something and have confirmation that it went through and them telling me they never got it. I agree with the others though that say get the papers yourself and send them. That way you have the control. You can send them and once you have confirmation call and make sure they have it.

Call & ask for the office manager, at doctors office. Don't get to upset until you're sure the MA didn't do what she said.

I have had a high-deductible insurance plan for decades, which has never had to pay one cent of my medical care, and yet they have routinely denied receiving records of the care that I paid for that should have been applied against my deductible, or they found some "official" reason to block applying those amounts.

I used to call to object and request explanations, and got only endless run-arounds from my insurer. It was exhausting, and I finally realized it was not worth the amount of time I had to spend trying. My daughter, who sold prescription medical supplies, would get the same run-arounds from insurance companies, but it was her job and she got paid to persist. It can take a long time. And it drives up the cost of the medical supplies that companies like hers sell.

She, and friends doing similar work, are convinced this is a tried and true strategy that insurers employ. They just grind us down, and have been doing this, NOT since the Affordable Care Act, but FOR DECADES. More profits to pay the CEOs and stockholders.

I finally gave up asking, and was seriously wondering for the past six years whether I wouldn't have been ahead keeping those expensive premiums and saving them toward the care I had to pay for anyway. But then, what if I'd had some terrible injury or illness? I sure don't want to become a burden to my family or society. So I found a way to keep buying probably-worthless insurance, just in case. It's an evil system, and it's hurting every person who needs medical care, which will eventually include just about every single American.

Don't assume that your doctor is lying, first of all. She very well could have submitted everything she was supposed to submit but the insurance company hasn't caught up on their date entry yet. It could be sitting on someone's desk in their in box waiting for them to get back from having the flu or vacation.

I would calmly call the doctor's office and tell them what the insurance company is claiming. "Hello Dr. Sarah. I've been following up with the insurance company since the pharmacy won't fill the prescription yet, and the insurance is claiming that they haven't received necessary prior authorization paperwork from you. I know that's crazy since you told me yourself that you submitted it a month ago. Do you have any idea how we can move this along?" Offer to drop in so that you can be there in her office ready to talk to the insurance company or sign any paperwork while she's talking with them in order to get it handled immediately.

I myself is an MA an this is something we battle with insurance companies daily. They will "not receive it" or "need more paperwork" or something.....they never make it easy on this kind of stuff. To assure my patients I am doing everything I can for them I will often show them the confirmation sheets I get proving the fax went thru. This has the date faced as well. Before you get someone in trouble maybe they can do the same. I always want my patients to trust me. If she can't provide this then I would be mad too! There are always confirmations whether they are faxed manually or scanned and faxed from the computer. :)

I've been caught in the middle between doctors' offices, hospitals and insurance companies. i find it can be helpful if you ask the person doing the faxing to fax the information to you at the same time as they're sending it to the next stop (in your case, the insurance company). When I get it, I then call the recipient myself, tell them it's been faxed to both of us & ask them if they've received it. Usually, this does the trick. Oh-- and take COPIOUS notes: date, time, who you spoke with, what action they're going to take and when, etc.

I know -- we shouldn't have to do this & should be able to rely on everyone to take care of their job effectively. Unfortunately, that's not always the case.

Hang in!

I have two ostomies. No bladder and only small amount of intestine. Supplier says I need script. We send. No one has it says never was done. Both the same doc n nurse for 22 years I know it was done. Sh calls when faxed. She does it again. Still cannot find. I go berserk on them. They find it. Now never have I had a problem. March 2010 when Obamacare was signed the problems all started. Now Medicare says supplies not medically necessary. I asked if I should use a zip lock bag and duct tape. Can you believe that! Now they say they need a letter saying I still have ostomies. Like I grew a bladder n intestines, they send off. Now five months later I go to order. They tell me I use too many. I use half of the allowed amount and that I need a script. Going crazy does not even come close to my reaction. One hour on phone and they send order out. Now I sit waiting. Never show because UPS delivers to someone else's address. I have only lived here forty years and my house number is highly visible. Now I have to reorder!!!!! Fast forward four days and the person brings package to my house. It clearly says MEDICAL SUPPLIES. So I feel your pain.

So don't be too harsh on your doc, chances are it was the insurance company that screwed up.

Just this past week I went to a new pharmacy for a new prescription, handed them my prescription card, and they told me that person wasn't covered. Really? He's been on there for 10 years. His medicine's last week at your competetor were covered.

Maybe she is using the wrong fax number? I would call your insurance company back, ask them to verify their fax number, and that the fax machine is working :)

Then I would call the doctor's office and *calmly* explain that your pharmacy is saying that insurance is still denying the auth. Could they please verify the fax number that they are sending too, and approximately what time the previous faxes were sent.

Call your doctor's office and ask to speak with someone in authority. Your MA has a supervisor. Talk with her.

I also suggest that she may not be lying to you. Others and myself have had difficulty dealing with insurance companies. She may be having difficulty with the insurance company or she may be new and not skillful dealing with them.

I'd give her the benefit of the doubt when talking with her supervisor. I'd calmly tell them what has happened, first just telling them that it's been 3 weeks and you still aren't able to fill out the prescription. Tell them the MA said it had been approved but the insurance company tells you that they've not been contacted. Ask her to expedite. If the MA has been at fault her supervisor will see that. You don't need to burden the supervisor with your anger. Emotions make getting the job done so much more difficult.

Once you've got the prescription approved then you can once more talk with the supervisor and register your complaint. I suggest that your goal now is to get the drug.

It is so frustrating. I understand your anger. I would feel the same way. I've been very frustrated dealing with beaurocracy. I've also found that calm and direct when saying what I need/want works much better than venting with authorities.

Don't jump to conclusions. Insurance companies are big. It's possible the fax went into a black hole. Talk to the office manager. Offer to pick up the paperwork yourself.

That's a long time to wait. I don't blame you for being upset, but whatever you do, BE NICE! Having an attitude will not get you what you want.

I wouldn't jump to the conclusion that she nevermind it.

I've spent 2 years rebilling 80 codes from the wrong insurance being billed.

2 YEARS.

Some of these codes I was faxing them forms 3x per week.

I have STACKS of "recieved, in process" receipts ... Stapled right next to "We never recieved..." Yes. You did. And HERE is the receipt saying so.

________________

Remember... Billing insurance, pre authorizing, etc. is a courtesy.
Most offices have a finite # of times they will attempt, before they hand it over to you to do.

It's not uncommon for a covered benefit to be given the run around.
When I was trying to get pregnant - my insurance coverage included fertility procedures.
We'd tried for 4 years before seeing a fertility specialist and when we saw one he told us that for our set of challenges IVF was what we needed.
So we (my doctor and I) set out to get the prior authorization that was required for the procedure.
It took 6 months of calling every few days to get it through.
I developed a close personal relationship with my contact at the insurance company to the point where I knew her vacation scheduled and who was covering her shift when she was out of office.
I tracked names and phone numbers, and the date/time I spoke with people.
Several times the paperwork was lost (on the insurance end).
I had copies of EVERYTHING and faxed what was needed every time they needed it to every fax number they gave me (and there were plenty of those).
I patched together conference calls between my doctors office and my insurance company on more than one occasion.
They sent it to the home office and I asked every day if it had come back.
FINALLY through sheer perseverance and ornery stubborn-ness and because I made it perfectly clear in the nicest possible way that the only way they were going to get rid of me was to process my paperwork and give me the approval I'd been seeking - I and my doctor got the official authorization!
We got pregnant first IVF attempt.
So - I know what you are going through.
Just because a procedure/medication is covered does not mean they won't give you the royal run around about having it authorized.
Hang in there and be prepared to bother them - doctors office and insurance company - every day till they give you what you are seeking.

Did you ask if you could get the paperwork and send it to them yourself? Sometimes faxes get lost. (I guess... I've had similar runarounds where one side says they sent it and the other didn't get it... so.. who knows?).

But, in my experience, offering to get the paperwork yourself and be responsible for delivering it, usually gets them to get it done. Whether it was really lost, or an oversight meant that it was never sent in the first place... if I say, "will you just make the paperwork available and I'll pick it up and get it to them" usually gets it taken care of swiftly.
Sorry you're having such a difficult time.

Conference call the doctor's office and the insurance company together, with you listening on the phone...

Dawn

maybe she is lying to you or maybe you spoke to someone at your insurance company that screwed up. Call the doc back and let them know you need this done TODAY