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