Not what I expected

[fbhjr]

Having been told I have to change my doctor, I took out my insurance card
in an attempt to change my primary care physician with my insurance company.

The front is covered with numbers, names, organizations and the like.
No phone numbers, emails or web addresses.

The back had a web address at the top and one at the bottom.

I plugged the bottom one into my browser.
It took me to a site that said it was for sale and had quite a few ads for
people promising then could help me send money overseas.
Hmmm.  And, that’s what’s printed on my health care card…

I tried the site at the top of the card.  It was a directory of doctors for
many different health plans, including mine.  There was even a customer
help section.
So I used that and wrote them an email asking how to change my PCP.

I got back an email saying: you don’t.  As long as they’re in our network,
you just show up and it will be OK.

Simpler than I expected.  And, the directory site did confirm the new
doctor is on my plan.  So, that should work out.
According to the directory, the new doctor is a woman too.
I’m happy about that too as they can give me any shots I need.

Comments

[pallid-regina.livejournal.com]

Uh...yay?

[fbhjr.livejournal.com]

It seems like a yay. But, we'll see when I actually meet the doctor...

[cissa.livejournal.com]

When I needed to find a PCP- this was several years ago, right after J got hired with benefits- I looked at the website.

A number of doctors around were supposedly tasking new patients. I started calling them (I rather needed to see one THAT DAY because I'd just gotten bitten by a feral cat- Miss Gigi- and needed antibiotics, tetanus, and possibly rabies vaccines if she turned out rabid which she did not). Also, it was the day before a 4-day July 4th weekend.

So I called, and called, and called... and bunches were NOT taking new patients. Finally I came on one that was and BONUS! She was right here in N'boro! So I made an appointment and went to the office listed... and lo! no such doctor was there. I finally found someone who knew of her, who told me that her office as actually close to the marlboro hospital, and NOT where the insurance company's website said it was; furthermore, she'd NEVER had an office in the building. Sigh. So now I'm late, and I call them and apologize profusely, and they're still able to see me and give me the tetanus and antibiotics...

And that was a damn good thing, because now NO ONE around here on our insurance is taking new patients, and not only did I get in, but J did, too, by association.

So! Thank you, Miss Gigi, for possibly giving me rabies! (Plus it was fun to joke, for the 10 days of her quarantine, that i was possibly a literally rabid feminist.)

(OK, yeah, I could have gone to the emergency room, but that was like $250 co-pay, and since all I needed was a script for antibiotics and a tetanus shot, it seemed silly. Plus it would probably have taken marlboro hospital 10 hours to manage that, based on previous experiences with them, such as the Horrible Mousing Incident.)

[brickhousewench.livejournal.com]

Plus it was fun to joke, for the 10 days of her quarantine, that i was possibly a literally rabid feminist

I think I love you. =D

[evrgreen.livejournal.com]

I wish you luck - it IS NEVER as easy as it would seem.

I had switched doctors from one back in Lebanon, to one in Concord. Then, within 3 months of that switch (and never having been able to get in to see the new doctor yet), the insurance company sent us new cards saying that they had switched our doctor/PCP. We then called the new doctor to make an appointment and were told that:
1. The clinic was not accepting new patients for at least 9 months
2. The doctor at the clinic which the insurance company had switched us to (without our consent, mind you) had actually left the clinic 6 months beforehand and moved out of state to work at a hospital. So, they couldnt & wouldnt help us, despite the fact that the insurance company had switched us to them and given us new cards with their (ex)doctors info on it..

We then had to find another new doctor, and after many calls, got the new clinic that we are now at. We spoke with the people at the clinic, insurance company, filled out forms online and in paper, sent faxes, and finally transferred all our medical records from the previous clinics to the new clinic. The insurance company sent us new insurance cards with the new PCP/doctors names on them. All seemed OK. I went to my first appointment4 weeks after officially switching my PCP and receiving the new insurance card with the new doctors name on it. The insurance company didnt pay the bill and I ended up paying for it. 3 monts later, my eye specialist tried to call for a referral approval for my regular glaucoma checkup. I had told them and my new doctor about my chronic glaucoma condition and that periodic checkups were needed and gave them the contact info for my new PCP. However, the insurance company refused to acknowledge the referral from the PCP. The eye specialist called me back, and after numerous rounds of phone tag, finally the eye specialist, the insurance company bill payment people, and I were on the phone together..

Insurance Woman: We will not approve/accept a referral from a physician who is not your PCP-

Me: I switched my PCP to this new doctor 4 months ago, filled out the paperwork and sent it in, plus I spoke over the phone with a person at your company to complete the process and verify that I had done everything correctly. Furthermore, your company has issued me new insurance card with the new PCP identified on it. So, how is it that he is not my PCP?

Insurance Woman: We still have Dr O (previous PCP) as your PCP and only he can be used for referrals.

Me: I did everything I knew to do, and called your company to make sure that I had done what I had to do to switch PCPs, and I have had all my medical records switched over to the new PCP office, and I have had 2 appointments there within the past 4 months. What more am I supposed to do?

Insurance Woman: We still have Dr O (previous PCP) as your PCP. IF you want to switch to a new PCP you have to follow the proper procedures.

Me: I Did follow them. Plus I called to make sure it was done. How come you work in the same company and you do not have records of this change, or even made the change?

IW: The customer/client support side of the business is separate from the billing approval side of the business. We do not have access to your medical data except what is sent to us.

Me: I did follow everything I read and was told to make the change. Why did your internal processes fail to process the change?

…. This went on for quite some time.. Finally I was able to get the Insurance Woman to admit that they had failed to process the change, even though they did have records that I had called to confirm changes made to our account/policy/provider over 4 months ago. I Requested that they study this example to make sure that they didn’t repeat the same mistake(s) over again.
Finally, the Insurance woman agreed to resubmit for payment the rejected bills that I ended up having to pay.

4 weeks later, I received new insurance cards, with the previous PCP on them. 1 week after that I Received new insurance cards with the new (correct) PCP on them. 3 months later I Received a check from the hospital – a refund for my payments to them as they had finally received payment from the insurance company.

[fbhjr.livejournal.com]

Wow.
Sorry it was so tough.

That is more of what I fear myself. But, they say it doesn't matter since it is the same office, same hospital affiliation and they're both on my plan.

I hope this isn't one branch says one thing and the other something else like what you faced!