Thursday, March 31

Irate Receptionist

2.5 weeks ago I saw the doctor for some problems that turned out to be related to very low estrogen. She prescribed some medicine, but told me to hold off on using it until some test results came back in "about 2 weeks." I also had a question about a possible change in dosing related to some breastfeeding issues. (Is this vague enough? ;)

Well, Monday was 2 weeks, so I called. The receptionist took my name and number and told me the doctor would call me back. Uh-huh.

Wednesday I called. Again, she took my name and number. She also admitted she couldn't find my chart. I called back at 4:45 hoping to catch them before they ignored me again, but alas, they closed at 4:30 and I had to miss another day.

This morning, Thursday. She took my name, then put me on hold. After 10 minutes, I was disconnected. I called back, and she took my name again. After another 10 minutes on hold, the receptionist picked up and said, "Camilla?" "Uh, no," I replied, and before I knew it I was back on hold. 10 MORE minutes. Then she picked up AGAIN and asked for my name AGAIN. This time I snapped, "MEGAN CLARKE."

"Okay MEGAN," she snapped back, "ONE MINUTE." And guess what she did . . . go ahead . . . guess. Yup . . .

Finally she picked up the phone and informed me the test results were negative. That was expected, and the go-ahead to use my prescription. However, I still had this question about dosage/usage. She told me she would have to . . . TAKE MY NAME AND HAVE THE DOCTOR CALL ME BACK. I told her to please pardon my skepticism. I asked if I could perhaps speak with my ob/gyn's partner instead. Nope, she wasn't in the office either. Were there any doctors there, I asked? No, she replied.

"How can a doctor's office be open without any doctors there?" I wanted to know.

"See, how it works is, they deliver BABIES, so they have to go to the HOSPITAL," she retorted.

I conceded defeat and hung up. Now . . . let's place bets. Will the doctor actually call me back?

Wednesday, March 23

Sick of Aetna?

I am!

I called them yesterday to verify that they needed information from all the doctors and hospitals they had told the pulmy's billing administrator about.

Nope. They told ME (at least she TOLD me! No crying HIPAA this time!) that they need only TWO things: the notes from the pulmy (which were mailed out on Friday, once they finally asked for MEGAN's information rather than JARED's) and the test results from the tech who performed the pulmy workup at the hospital. Nothing from any hospitals or doctors in California. I made her double check. She claims that when those two files arrive, the claims will be paid out.

I'll believe it when I see it.

Monday, March 21

Aetna: It's War

I am trying very hard to remain calm and rational. This is WAY beyond my usual Wendy's fiasco. This is going to be war.

Remember the Aetna saga? They have neither approved nor denied three separate claims (for $800+, $123, and $300+) pertaining to a pulmonology appointment and a pulmonology workup I received while I was pregnant in October 2003. They keep insisting upon "more information" from myself and various doctors to confirm this was NOT a preexisting condition.

The only helpful person so far has been the office manager of the pulmonologist I saw. She has been going to bat for me-- and trying to get these claims paid out.

Today I got a letter from her. (Note: the pulmonologist will be "Dr. M." herein.)

Dear Ms. Clarke:

I am writing to you to keep you up to date on the pending claim that is still unpaid by Chickering [underwritten by Aetna.] The date of service was 10/22/03.

I spoke with a Chickering representative named Betty today, and was told this claim will remain unpaid and pended because of several reasons. Chickering needs operative notes [note: operative? Needless to say, I did not undergo any operation] from Dr. M., which I will obtain and send to them. They sent 2 letters asking for these notes, but they put the patient's name as Jared. Dr. M. sent back both letters, marked "not my patient." They send a 3rd corrected letter on 2/14/05.

Betty stated that Chickering also needs notes from [the hospital where I had the pulmonology workup and gave birth], a hospital in California, and a Dr. G. in California. She said that letters went out to these entities as well several times.

Lastly, Betty said that the form that you sent to them was incomplete, and that they need a completed form from you. She suggested that you call them to get this claim payment expedited.

I have little hope that this claim will be paid, but I thought that I would let you know the status. If you could please call Chickering, it would be appreciated. I have done all that I can do to get it paid. I have called them several times, and talked to supervisors, and representatives. Their stall tactics are frustrating, and I don't have any other recourse than to ask for your assistance. I will send them the notes from your chart after I receive them from Dr. M.

Thank you in advance for your attention to this matter. I may be reached during normal business hours at [number.]

Billing Adminstrator

So, to recap: 17 months after the fact, Aetna has neither approved nor denied 3 separate claims pertaining to the same issue (namely, pregnancy-indued asthma.) Because the claim is perpetually "pending" I cannot appeal it, since there is no ruling. When I have called Aetna, I have been told that they "need more information" from "two doctors." I was told that due to privacy laws, they could not TELL me who those doctors are.

However, they evidently have no qualm telling the billing administrator of the pulmonologist's office who those doctors are. They are: the ob/gyn I saw in California before we moved, a hospital in California where I went with an asthma attack before we moved, and the hospital where I had the pulmonology tests (and also delivered my daughter.) Side note: we had different insurance when we lived in California; Aetna is not being asked to pay for those claims, they apparently just want the records to see if my story is consistent-- namely, that I had no history of asthma before pregnancy.

Additionally, Aetna has sent out letters to these entities "several times"-- but considering they were requesting the records of the completely wrong person from the pulmonologist (Jared instead of Megan), it is not unrealistic to speculate that perhaps the hospitals and CA ob/gyn were also receiving requests for the records of my husband, who, I am fairly sure, has never had pregnancy-induced asthma. (How confused that ob/gyn's office must be . . .)

So. This is war. I don't know whom to call or what to do, but this is ridiculous. When a seasoned insurance billing administrator is expressing frustration with Aetna's "stall tactics," something is rotten in the state of Maryland.

If you are reading this and have any idea of where I should turn next, please PLEASE e-mail me. Because I can't even find solace in a cheeseburger. Wendy's still gets it wrong.

Saturday, March 19

Aetna: So Bad I'm At A Loss For Punny Titles

Jared called the hospital about the $123 for which we were sent to collections (see archives.) Apparently they realize the bill was sent to us in error-- that they should bill insurance first-- but when they submitted the bill to Aetna, Aetna informed them that Jared and I are not "in the system." That's right, folks . . . they paid out for prenatal care, labor and delivery, postpartum care, pediatric visits, and all the incidentals of normal medical coverage, but now we're not on their radar.

Maybe they could find it in their hearts to cover a few Valium. I think I need them.

Saturday, March 5

Petco: Treated Like A Dog

The poor turtles have been neglected for awhile. Their filter has been a lemon from the beginning and desperately needed replacing; their full-spectrum light burned out awhile ago and we hadn't replaced it. So today we put Petco on our errands list.

Our local Petco is kinda cruddy, so we drove farther to a different one. From the outside it looks big and nice. But they lost brownie points right off because they had no carts anywhere to be seen. I had the toddler on my hip and the diaper bag on my shoulder; Jared was carrying the Floppy Seat; we were looking to buy a large filter and large bulb-- we needed a cart. I asked the nearest cashier, "Excuse me, where are the carts?" She looked at me, raised her eyebrow, and said, "Outside?" Unspoken P.S.: Duh, lady. "There aren't any," I replied. She looked around and shrugged. "We've been busy."

Okay, if there were really 30 carts in use, I can understand that. But the store was almost empty and there were STILL no carts. And of course nobody cared to find one for the lady lugging the baby.

Anyway. Jared went to inspect the filters while I looked for the bulb. There was a very distinct smell-- so I kept discreetly sniffing my kid's diaper. (Okay, I lied. There is no way to discreetly lift a child above your head, stick your nose near her crotch, and inhale.) But the diaper passed the test each time. Then I realized there was a very LARGE pile of dog crap right behind me-- I'm lucky I didn't slip in it. It was in FULL VIEW of the cashiers AND the guy in the fish department, and nobody was doing anything about it. Just charming, really. (Not to mention the owner of the dog who did it-- where was s/he?)

I grabbed the bulb and met up with Jared, who was lamenting the fact that the only filter left was in a battered box that had obviously been opened and returned. He was hesitant, but I told him we could always return it if it didn't work or turned out to be missing parts.

Then we decided to give the cat scratching posts a quick peek, for Schrodinger's benefit. (Translation: if Schrodinger keeps scratching the carpet and walls, we will kill him. A scratching post will therefore benefit him.)

So, lugging our loot and the baby and the bags, we made our way to the cat section, this time nearly slipping in a huge yellow puddle of dog pee. Okay, I REALIZE that pets are welcome in the store, but this is getting ridiculous.

Didn't find any posts (that is, didn't find any NOT shaped like a castle priced at $60) and headed to the check-out. As I put the bulb down, Jared said, "Oh, that's a UVB light, not full spectrum." I looked; he was right. I asked the cashier (Jason), "This is the only kind I saw-- do you have full spectrum bulbs?"

He replied, "Uh, I don't know, I just started working here. I buy mine somewhere else."

I blinked. "Do ya think you could ask someone and maybe find out?"

"Oh, okay," he replied. He picked up his register phone and paged Greg. Then we all stood there in awkward silence. A growing line was forming behind us. Greg was nowhere to be found. As Jason paged Greg again, I noticed It.

Underneath the word "Jason" on his name tag was the word "Manager."

I burst out laughing. I pointed it out to Jared (while Jason was looking over his shoulder vainly for Greg.) ONLY ME. I rubbed my temples. "Never mind," I told Jason, and we left without making a purchase.

We ended up back at our cruddy local Petco, which actually had the filter in a nice new box, had the proper light, AND had cute baby ferrets the lady let me hold.

Wednesday, March 2

Online Purchase Meet Mr. Credit Card

Thanks to a nice little tax refund, we decided to buy a new digital video camera. (We bought one in 2002 and it just died in late 2003 . . . right before Aurora was born, naturally. So I have about 6 tapes full of "stock footage" of Disneyland [my hobby!] and none of my kid.)

Being the savvy electronics consumer I am, I did my shopping/pricing online. We selected one, we played with it at Best Buy, and then I ordered it online from a brick-and-mortar camera shop in New York City that retails online. That was Monday. I saw a confirmation e-mail in my inbox ("Your Order Number Is BlahBlahBlah") but didn't bother opening it (I had it sent to my "junk" Yahoo account, the one I use for all online orders, lest my real addy become spam fodder.) Today, Wednesday, I decided to read it and see if it had a shipping tracking number or something.

Instead, I was nonplussed to see it was actually a "random verification" requiring me to call the New York store to confirm my order. I did.

I was informed that my credit card number did not match the billing address I provided. He had me repeat my address, and informed me that no, it did not match. Funny, in the 19 months we've lived at this address, we've gotten 19 monthly statements and made many credit card purchases without incident . . .

Then he transferred me. Ha ha! OF COURSE HE TRANSFERRED ME . . .

The second guy was almost a little too helpful. He had me repeat my address, informed me that it didn't seem to match, but it must be a "a computer error," he was correcting it right now, and the camera would ship today, and he'd call if there were any more problems.

Frankly, my instinct tells me THEY screwed up and were just CTA, because it was resolved without my slagging through a mountain of bull$h!t. Ah well, I'll take it.