Wednesday, July 30, 2008

My head hurts

The thing that sent us off on the insurance tizzy was that when I called the family practice doctor that one of my husband's coworkers highly recommended I was told that they were not accepting new patients. My husband had put him down as our PCM with out verifying that he was taking new patients. So, I thought I would find a local pediatrician for the boys so that we could save gas and not have to do the 28 minute drive each way every time the boys needed the care of a doctor.

We have talked to Tricare a number of times and each time we get a very different answer. Yesterday it was a simple form that the doctor's office would have to fill out. The next call there was nothing that they could do. Today it was a form that we could fill out that would exempt the boys from needing a PCM. Then later when my husband called again, he was told that this could not be done. I think the only true piece of information that we have gleaned from this was that the person that told me that the family practice doctor was not accepting new patients was mistaken. I still am unable to wrap my mind around the fact that the local doctors can accept Tricare but not be PCMs. To me that is like saying that we accept a credit card, but you can't actually use it in our store to buy anything.

So now the boys have an appointment to see the family practice doctor next week, it was just not worth the headache to insist on a pediatrician. We had a lot easier time scheduling an appointment to see this doctor which I like, but I am just frustrated with having to do such a long drive when there are plenty of doctors that are closer. I also hope that this doctor can handle Evan and all his needs, after all he is a pretty complicated little guy.

13 comments:

Our Family said...

Oh, your struggle reminds me of so many "insurance arguements I've had". I remember crying on the phone with the claims department explaining that "when your infant son is trying to die in the hospital, you don't remember to keep a log of all the expenses he is acquiring". Just stay tough, stand your ground, and make sure your boy doesn't get pushed aside. Once the doctor meets you, and understands your son's needs, your family will probably have VIP status...if not..find a new doctor!
Gina

Amber said...

Dealing with insurance is a nightmare. We've had a lot of problems switching over since Jamie changed jobs. Hopefully you find a wonderful doctor who will be a great help to Evan!

chichimama said...

Good luck-

We have actually found a family care doc to be fabulous, and choose to drive 35 minutes to see her even though there are many doctors closer...much more in touch with the family unit and dynamics.

Karen (Pediascribe) said...

I'd be calling Tricare and insisting on a supervisor. I hope you're documenting who you spoke to and when and what they said.

When I get really frustrated and I call customer service, they say, "Can I help you?" and I say, "I seriously doubt it."

HA HA HA HA

The Woman said...

I hate it when places give you 20 different answers to something its like hey get your answers straight. grrrr

Zephra said...

I remember arguing with the insurance "are you telling me I should have asked every body that walked through my daughters hospital room if they are on our network? They are all working in the network hospital!"

I had to pay an $800 bill but now I kn ow better. Try to ind the e mail of the higher ups and mass e mail the problem. This worked great for me and Sprint and it could not hurt to try.

Anonymous said...

Insurance companies have too much power. And why does everything have to be so complicated?
We're in the process of changing our medical insurance right now, having to pick a plan, learning new rules, etc. etc. !
diana

Guinevere Meadow said...

SO frustrating!! So sorry you're having to deal with this. Trying to educate a new doctor about your family's needs is complicated enough without worrying about insurance!

moomy said...

cheer up! soon we will be there to cause confusion and havoc!

Heather said...

I hate the run-around. I wonder if they have to take a test to make sure that they all know to give a different answer every time a person calls.

The Laundress said...

Picking a new primary care doctor is a huge deal. I would have scoffed at this, a few weeks ago.

But just lately,

My best friend's doctor retired.
These things happen.

No big deal?

Except:
my friend does not drive, needs a doctor on a bus route (huge new clinics have sprung up on our city's fringes, outside of public transportation! Far fewer choices available in town.)

My friend has some serious health issues that require close monitoring.

We have been perusing physician profiles of available doctors (and, at first, I thought my pal was being a silly crank) but dang -- there are some dcotors very upfront about their "Christian value" convictions" -- does this mean not Gay friendly??? wish they would explain a bit more!!!

Even more that are very into sports medicine and rehabbing football and soccer injuries (therefore, same as above), etc.

Suddenly, it seems like my friend's best "doctor", as offered by his HMO, is a late-middled aged, lesbian nurse-practitioner. It is just really hard to read between the lines. How many "dropping in" or "just checking" visits are allowed? It IS a big deal, who your doctor is and what their values are...

Vicky said...

The US health insurance system sucks, from what I read.... It seems like a few people get state of the art care and a whole lot get nothing. And the ones who get the care have to jump through endless hoops to get it.

Compare that to Japan where most people get a bit of care for a bit of money, quickly but with no bedside manner, no provision for children (no therapists, no child life people, no counsellors, no nice rooms with bright curtains) and often not enough or even no pain relief.

Or England, where everyone gets free treatment, often extremely high quality, IF, and this is a big IF, you haven't died before you get to the top of the list. I know of which I speak as my aunt and my Grandmother both have terminal cancer that was not caught despite repeated complaints of ill health (stress, dear, you're getting on, dear etc) until it was way too late. Now they are getting excellent care but it won't save them.

So which of those three sucky systems is better?? I wonder if there is a country that has pretty much got it right? And if so where is it because I want to move there!

much more than a mom said...

Oh my - the US health care system is scary isn't it? Good luck!