Friday, February 1, 2008

HMO Moves a Molehill for Me

Insurance companies have been known to be villains in medical dramas. Who hasn't spent hours chasing down referrals, checking the status of authorizations, filling out claims forms and punching their way through the voice mail menu at the customer "service" center? I've been a member of HealthNet HMO since 1988. I've jumped through hoops for them over the years but have always been able to receive coverage for the services needed. Okay, maybe a few exceptions but they've come through with the big items.

Today, it was the Medical Group that screwed up and pushed me to tears. HealthNet and most insurance companies get such a bad rap that I want to say they were the White Knights today. They made up the three weeks delay caused by the Medical Group in less than an hour, approving an out-of-network second-opinion visit to an oncologist of my choice for case and treatment review.

The Medical Group sent me a letter several weeks ago telling me they had faxed the information to HealthNet for review. When I followed up today, realizing that silence is never golden when it comes to insurance, I learned that the phone number listed in the letter connected me to the Alabama Department of Agriculture. Not HealthNet. (Off by one pretty important digit.) And the Medical Group had sent me the wrong form letter to begin with; I was supposed to get the one telling me follow up with HealthNet and get my own information faxed. Or something. End result: HealthNet had received nothing.

Well, the urgency to the matter is that on Monday morning at 10:00 I have the second opinion appointment. If it isn't preauthorized we're responsible for the $500. Maybe HealthNet would reimburse us, maybe not. On Wednesday we take the second opinion to the New Patient appointment with my new, improved Agent of Doom. These appointments all require supporting childcare, husband work rescheduling, records gathering. At 4:30 pm today it looked like the calls back and forth between the Medical Group and HealthNet would get me an answer by Wednesday of next week. Too little, waaay too late. Oh, that's all it took to get the tears flowing.

No one heard me crying. I pulled it together between phone calls. The customer service folks were actually kind, something I've noticed now that "oncology" shows up next to my requests. And when the HealthNet folks understood the issue they reviewed the request while I was on the phone and two of them gave me the news on a conference call. I mean, wipe me up off the floor and tuck me into bed.

I guess it says a lot about our health care system that getting a "yes" from an insurance company in a reasonable time frame, with respect and kindness shown to the individual, is news. Forget that I had to spend the day chasing the "yes" down. It is still a "yes" and one I am grateful to have received. Go, HealthNet. Be kind to the little cancer chicks.