Fixing Things. It's What I Gotta Do.......

Let's see....

Since our last little cliffhanger, (Cancelled....) I've spent about 2 hours on phones, off and on, trying to make all of this work somehow.  Each call has landed on a different day.

First, a second call to Nemours to see why, after nearly two days, they haven't called back.

Next, and longest, was the insurance company. Finding out what was holding up the Botox was...opaque, to say the least.  The number on our pharmacy card reaches the mail-order pharmacy, which is a fairly useless (to us) place. We found out during the Great Transplant Medication Shortage (The Terror of Running Short....) that this is not actually considered to be OUR mail-in pharmacy (We can get 'ordinary' medications mailed to us from there if we want, but it is more expensive than using out local pharmacy. And for 'special' medicines like transplant stuff, we have to use our local pharmacy, 'cause THAT's our ACTUAL mail in pharmacy, even though we just walk in and pick them up. Don't ask me. I'm just The Fixer.). But I had to start somewhere, so....

The very nice lady who answered wasn't sure what the issue was, because Botox is in a Super Special Category that is neither "regular" nor "mail order," so it wasn't her department.  "I'm going to need to talk to someone else, and it could take quite a while. If you don't want to listen to the whole thing, I can put you on hold."

Well, honestly, I'm still at work, and I have a lot of charting and dictation to do that I really don't want YOU to listen to, so sure, sounds like a plan.  "Do you think I'll have time to run to the bathroom, because I probably should have done that before I called you!"  She assured me that if she comes back on and I'm gone, she'll wait for me.

No need to have worried. Fortunately, the Muzak was  not too grating, because a full hour after I got back to my seat, she came back on.  It turns out that the Botox authorization WAS still attached to Nemours neurology.  She could see a record of ONE call from the new neurologist requesting that it be released to them, but no calls from Nemours allowing it to be released.

By the time I had this information, it was too late on Thursday to call Nemours again.  Friday I got ahold of the injections scheduler, and she said the reason the provider hadn't called back was because she was concerned that they wouldn't be able to get the Botox, because it had been released to the new provider. Well, damn skippy. "As a matter of fact, no, it has NOT."  I filled her in on what the insurance company had said, and she was a bit miffed at them, since she herself had called them.

(So either she never called, or the insurance company made no note of the call and failed to release the medication that my kid needs, making it necessary for her to WAIT an extra three weeks. I'm placing ALL my money on it being the insurance company. I've been playing this game with them for more than a minute now.)

At this point, we are running out of options. I'm going to assume that our appointment with the new neurologist is, in fact, cancelled (something that I confess I have failed to confirm one way or the other since this all began.  If I ask her to release the medication now, this will likely backfire badly; and honestly, I don't think I can be polite to the scheduler in the new doctor's office at this point.

So:  "Can she be fit in when we are coming down in December? I'll clear my schedule and come a day early, stay a day longer, whatever works."

I got a call at the end of today:  She has an appointment.

I admit I cried when I put the phone down.  I just needed a minute. I am getting too old for this stuff.

DeeDee

Cancelled.....

Babygirl is due for Botox injections every 12 weeks, so she should have them November 21. Due to miscellaneous scheduling issues, our new local neurologist set her up for November 25 when she first met him back in August.  Shortly after that appointment, his office called me.

"I'm trying to get authorization for the Botox, but your specialty pharmacy tells me that there is already a prior authorization in place elsewhere that needs to be cancelled so we can set one up here." 

No problem. I'll call them. 

Nemours informs me that cancelling the PA isn't needed, the new doctor just needs to ask the insurance company to transfer it over to them.

I'll let them know.

"I've contacted your insurance and they assure me that the other hospital needs to cancel the PA before we can proceed." 

Got it.  I'll let them know. In person, since we happen to be going down there.

"We do this all the time, and we know they are wrong, but we'll be glad to call your insurance company and talk to them."

Somewhere in the middle of all of this, I called the insurance to see if I could get a handle on where exactly the problem was.  I'm pretty sure they told me the new doctor only had to submit the appropriate paperwork.

I let them know. And that was the last I heard about it, likely about 3 weeks after we saw our Nemours neurologist for her last set of injections at the end of August.

Today I got a message on my phone while I was at work.  "We're just letting you know that we don't accept your insurance for Botox. Give me a call and let me know if you want me to put in a referral to the pain management center."  Hmmm....refer us to Pain Management, at the hospital where I DON'T work, when my JOB IS PAIN MANAGEMENT at my OWN hospital????

Problem is, we aren't set up for Botox at our center (yet) and the other neurology group doesn't do it at all.  And our insurance barely covers the other pain management group - Hubby used to go there and our bills were outrageous.

So I call back.  The lady who has been working on the PA is clearly frustrated, and tells me: A) Nemours still has not "released" the PA they have on the Botox, and she has tried NINE TIMES to get the paperwork through, and B) even if she does, our insurance is apparently famous for authorizing it and then not paying for it anyway (which, if you knew that, WHY did you not say so 3 months ago?).

Well.  I can hear that she's frustrated, and I understand, but she's at least 10 levels less frustrated than I am.  I have a kid whose headaches are already in pre-Botox ramp-up mode and she's been suffering pretty badly for more than a couple of weeks, and the shots as planned were already going to be half a week late.  Even if she refers me to the other place, there is NO CHANCE that we will get in in less than a week for those shots. 

"I can pay for the Botox. We have a Health Savings Account, it's no problem."  "How can you pay for it if I can't even GET it for you?"

Frackin' crap on a cracker. I. Just. Can't. Even.

I put in a call to Nemours Neurology. We have to go to CHOP on December 12, maybe they can fit us in (but by that time we will be THREE weeks overdue).  They are checking schedules and will get back to me. Tomorrow I'll call our insurance and have a WTF conversation with them.  And if all else fails I'm going to have a come-to-Jesus doctor-to-doctor conversation with a specialist that I've been sending patients to for literally more that 20 years, and let him know that he owes it to ME to take care of my kid, just this once. 

I've never called in my chips on a specialist before.  But this may be the time.

DeeDee