Atrial Fibrillation (AFib) Support Group
Atrial fibrillation (AF or afib) is an abnormal heart rhythm (cardiac arrhythmia) which involves the two small, upper heart chambers (the atria). Heart beats in a normal heart begin after electricity generated in the atria by the sinoatrial node spread through the heart and cause contraction of the heart muscle and pumping of blood.
Up until now, and for the last 40 years or so, I had nothing but god things to say about my health insurance. After all I had worked for the State of New York for 23 years now retired, and the coverage is far more extensive than anything I had seen in the 20 years I latter worked in private industry. There's one insurance company for hospitals, another for doctors, and a third for drugs (lucky me).
I am now convinced that the insurance companies are trying to kill me.
This started last Friday when I tried to renew some prescriptions. Seems we have a new drug plan administrator who likes to make up new rules without telling anybody!
Next comes approvals for my ablation and pre surgical tests. The insurance woman at the EP's practice assures me the ablation pre approval is fine (of course, you always get the bit from the insurance company either via paper or their automated attendant phone system saying that just because you got a pre-approval, doesn't mean they will pay for anything - my lawyer gets a copy of this). Nothing like getting a $100k billing the mail
Next comes the blood work. We were planning to have the pre-op blood work done at the class 'A' hospital the EP's are in instead of the usual Labcorp that the insurance company insists on. Now you know at in an ordinary lab a suite of blood tests run just under $1000 (my copay would ordinarily be $20.00). However, with anything in a hospital the sky is the limit (like $89.00 for a box oft issues -- a mucous recovery system). So I wanted to make sure the insurance company would pay for blood work prior to surgery in the hospital. After four hours yesterday, and whiplash from all the bouncing around I got, I finally gave up (it's an ugly story). I will go to Labcorp for my blood work instead of the class 'A' hospital!
Next comes the preapproval for the CT Angiography to be done one week before the surgery. The EP's insurance person is now up to 15 phone calls, and I'm up to 4. This is insane! You must have a preapproval but you can't get through their system! God knows how much this would cost me without a preapproval. As of now, I do not have the preapproval for this test.
I always helps to rant ... thanks for listening. Yes, I know my paranoid side is showing. Next stop is the NY state senators office which is fortunately 2 miles up the road. I guess the insurance companies figure they got your money a long time ago, so now you should just die and stop taking THEIR money! Hope I don't get arrested or carted off to the Looney bin.
I am now convinced that the insurance companies are trying to kill me.
This started last Friday when I tried to renew some prescriptions. Seems we have a new drug plan administrator who likes to make up new rules without telling anybody!
Next comes approvals for my ablation and pre surgical tests. The insurance woman at the EP's practice assures me the ablation pre approval is fine (of course, you always get the bit from the insurance company either via paper or their automated attendant phone system saying that just because you got a pre-approval, doesn't mean they will pay for anything - my lawyer gets a copy of this). Nothing like getting a $100k billing the mail
Next comes the blood work. We were planning to have the pre-op blood work done at the class 'A' hospital the EP's are in instead of the usual Labcorp that the insurance company insists on. Now you know at in an ordinary lab a suite of blood tests run just under $1000 (my copay would ordinarily be $20.00). However, with anything in a hospital the sky is the limit (like $89.00 for a box oft issues -- a mucous recovery system). So I wanted to make sure the insurance company would pay for blood work prior to surgery in the hospital. After four hours yesterday, and whiplash from all the bouncing around I got, I finally gave up (it's an ugly story). I will go to Labcorp for my blood work instead of the class 'A' hospital!
Next comes the preapproval for the CT Angiography to be done one week before the surgery. The EP's insurance person is now up to 15 phone calls, and I'm up to 4. This is insane! You must have a preapproval but you can't get through their system! God knows how much this would cost me without a preapproval. As of now, I do not have the preapproval for this test.
I always helps to rant ... thanks for listening. Yes, I know my paranoid side is showing. Next stop is the NY state senators office which is fortunately 2 miles up the road. I guess the insurance companies figure they got your money a long time ago, so now you should just die and stop taking THEIR money! Hope I don't get arrested or carted off to the Looney bin.
I agree totally, Ins. is a nightmare. I have found, the person at the Dr.s office who handles the ins. claims is the key. If you have an efficient one, it seems to go better. But, I know, I have been on the phone and online for the better part of many days and totally frustrated!
I have my fingers crossed for you!!!!!!
I guess the worst part about this is it SHOULD be about YOUR HEALTH and not about your health insurance. So, get some of that mucous recovery system, wipe your forehead and get back on the phone! (Do you need to get these preapprovals in writing?) Be sure to take some time out, drink some tea and make sure your blood pressure isnt rising!
Completely cheering for you!
Take care.
I am currenlty waiting for pre approval for a three week monitor so I can get off all these meds since I had the ablation in December. A very slow process even for just a monitor and several talks with my "health advocate" from the insurance company and no monitor in sight yet.......
Not the best medicine for those of us already struggling with the vagaries of afib. Hoping you'll find your way through to sane help.
So sorry to hear about the insurance problems....I think I previously mentioned that Tricare didn't contribute a dime to my ablation cuz they said 1) I didn't run it up the chain of command (Hopkins handled the approval for Blue Cross, but the Army said "NOPE!" and 2) Ablation is an "experimental" surgery. Apparently has only been done once or twice before, so....but you are fighting, God bless you! And you will win, I am sure.
On another note, I have to tell you that you caused me to miss one of the answers in the Washington Post Crossword yesterday. Hint: Singer Dion, 6 letters. I figured Damucci, but that was 7, so I cut out one of the Cs. Damuci, nice fit. My wife went to finish up the crossword (she is SO much better at it than I am) and said "Dion Damucci? HOW OLD ARE YOU?" The answer of course was "Celine." Another example of old age...when I hear the name Dion, my first thought is of the Belmonts.
Another day older Bill
P.S. Don't let this stress you, my brother! You will be on the table soon!
Since I have terrible cell reception in my home and the cardiac telemetry stuff wants to talk through the cell phone system, I thought it would be a good time to talk Verizon down on a signal booster. It's normally $250. I talked them down to $200 with my medical sob story (that's still $200 to get the cell phone to work that I already pay for). At least I dodged the contract pitch. They wanted me to move from my $100/year prepaid phone to a $600/per year contract in order to save the $50 on the booster. I guess the math is beyond most people so the companies just continue on their merry way. Only in America.
The road now may be clear ahead (I hope), two weeks to 'A' day.
Opsyn :: I hope you're taking notes on all of this. What is it, 5 weeks to go for you?
Whattsamattahfoyou? It's DiMucci!
petey (last name is 9 letters and Italian ending in vowel)
Good luck in working through the insurance bureaucracy.
My ablation is scheduled in 4 weeks. So far no insurance snags. One of the reasons I selected my ep is that I thought he had the best run office of any of the 3 ep's I spoke to. So far they have been outstanding and have communicated beyond my expectations via in person, telephone and email followups.
My big insurance concern was the issue Bill brought up regarding ablation being experimental and also requiring that you have failed one or more anti arrhythmia drugs prior to approval. I have read their policy and this is not the case
I suspect any insurance problems will surface as I get closer to the date. Worse case I believe is that I am out of pocket $2K which gets me to the limit on my policy
opsyn
Sound familiar
Sorry 'bout dat...some of the other gumbas from the 50's helped us non-Italians out..Fabian, Frankie Avalon, Franki Valli (uh oh, did I spell that one right?), I guess Dion decided he was big enough that people would just learn.
Paul, I would LOVE to visit Belmont Ave one day! We will have to work it out for sometime later in the summer, when you are back to running and pumping iron!
Sorry about the spelling...we Irish kids just aren't that smart!
Bill
Some insurance companies are easier to work with than others. We had several people dedicated to setting up referrals and tests, and getting the insurance auths. Make sure you find out who that is in your Drs office and deal with them...they will be the most helpful in getting your auth.
Paul...we don't have good cell phone service at our house either. Didn't know you could get something to boost the signal?? Is it a one time charge? We may have to look into that.
Best of luck with your ablation...keep us posted.
Try it!