Saturday, June 16, 2012

Finally approved....Yeah! Why do health Insurance company's get away with how they treat patients and clients?

As most of you know I spent almost all day Thursday on the phone with Wellcare my Medicare Advantage plan trying to get approval for my surgery on Monday.  That is right I started on the phone at 10:30 am and was on there bouncing around from one area to the next til 6:45 last night. I went through so many hoops and had to repeat and explain myself over and over again. Finally I got a supervisor who finally understood what I was asking, and routed my call to a supervisor on the escalation team and she finally gave me the answers I was looking for.  By the time I got off the phone with her all the Doctor's offices were closed for the night and nothing could be done till today.

It took several more hours today on the phone to finally get approval for my surgery. Finally at 4:00pm today I was called by Wellcare and the surgeon's office that I needed to be at the hospital at 5:30am on Monday for surgery as planned.  You can find out more about what I went through on yesterday's blog. Take a look at them and let me know what you think. But let me tell you this with the way that insurance companies control how a patient is treated and what types of services they can receive I can see why this country seriously needs some healthcare reform.

I am hoping that as the new legislation nears completion and new changes go into effect that the patient is given better control over the treatment they receive and can participate more closely with their medical team to ensure that their problems and issues are getting addressed without having to jump through hoops and having to cut through so much red tape.  The major problem that I faced yesterday was getting authorization for this surgery, everywhere I turned I kept getting the same answer over and over again that I needed to get my primary care provider to call in to the insurance company and get the authorization.  The problem is my primary care doctor resigned from her practice two weeks ago and left no forwarding information.  There was no one at the practice that could call in for the authorization and I kept getting bounced around and around.

I am so glad this whole unfortunate business is behind me and that I can get on with my surgery.  I hope none of you have to go through this type of situation, but if you do, know your rights as a patient and a client there are so many laws in place to protect you and guarantee your rights.  Make sure you use them and fight for what you need.  Remember that it is your life and your health, and if you don't have good health what kind of life do you have?  Insurance companies in the United States have way to much power, and they can decide your fate without ever knowing what is really afflicting you.  If you are like me and have a terminal illness I bet you know the ins and outs of your body and know when you are not feeling right and can usually pin point out what is going on way before the doctor's or nurse's do.  Make sure you stay proactive and when problems arise be willing to be vocal about your concerns.

If we don't take a stand against being walked over by insurance companies, and we are not vocal to our elected officials, we are going to keep being treated as a number and the necessary treatments we need will slip through the cracks and we will keep getting denied.  It is a shame that most insurance companies deny all initial claims and we the customer that pays for this insurance has to run around and jump through hoops and have to demonstrate proof that we really need the service that was denied. I think as we get closer to the Presidential election you are going to see that healthcare reform is going to become one of the highest priority issue.  Please make sure you get out there and vote and make sure you keep in mind who is going to be working for the people and supporting your needs versus someone who is going to stand for the insurance companies against the middle class.

I am only putting my pain out there for you to see and hopefully you will see that something must be done to hold these insurance companies liable for how they act toward their clients.

As always my hopes and dreams are with you,

Uncle B