Wednesday, October 13, 2010

But Wait, There's More

I just talked to MinnesotaCare. I was calling to see if they mailed the Term letter, and to which address.

Apparently the guy I talked with the other day (Sayid) did not actually update my address.

The very cranky woman that I just spoke with today (after I waited on hold for 20 minutes to talk to them) put me on hold for another 30 minutes trying to get ahold of the Department of Human Services (DHS), trying to request the termination letter. Apparently it's not as easy to change the address as Sayid had thought, as there were many things he did not do.

I couldn't actually get a word in edgewise and I had to say perhaps 10 times, "okay, hold on, I just want to make sure you're understanding what I'm asking," and she continued on explaining things that I already knew, off-topic from what I was asking.

After having me on hold with DHS (unsuccesfully) she mentioned that she wasn't allowed to be on a call that long. I said "...but I still have questions..." and she terminated the call.

She volunteered to send me a printout of her screen showing 0 balance and no coverage as of 9/30, which is not an official Term letter but may suffice. THe best she can do is send that through the postal system. SHe has no idea how long it will take to get the Term letter from DHS at the new address. Hopefully just a few days, but then it will be too late.

I'm rescheduling the surgery.

14 comments:

M said...

Update:Checking with Mayo to see if they can do just the the bladder biopsy independent from the surgery, which (at least if I have to cover it out of pocket temporarily until I get reimbursed (hopefully) by MCHA) is doable in the short term.

THe first dates they gave me on the phone for rescheduling was in early December. This is one of the downsides of going to one of the the world's experts. If it was just a simple a matter of pushing it all back a few days I would have done that long ago.

If we did the biopsies now, this would mean that at least we have a clear idea of what *type* of surgery he wants to do, when we actually do it in a month or so. But this is a worrisome delay for a high-grade urothelial carcinoma.

I'm also checking with Karen at Gallagher to see if there's a way to skip the termination letter process. She mentioned earlier that she'd found out that one *could* have MinnesotaCare at the same time as MCHA. So if that's the case, why do I even need the Term letter anyhow? I left a VM for her asking her this very same question. Perhaps it will all be fixed magically on its own in the next few hours. By elves.

I still *may* be going to Rochester tomorrow. Stay tuned.

M said...

Just talked toe Karen at Gallagher. No. Since I Termed MinnesotaCare (even though I do not have the letter) I still cannot do the MinnesotaCare/MCHA thing in tandem. Again, if Karen had mentioned this up front I wouldn't have Terminated MinnesotaCare and we wouldn't have this problem.

M said...

If anyone has any ideas for something I've overlooking or missing I'd be happy to hear it. I'm fairly spent on this process and am nearly to the fetal position stage of dealing with this entire mess.

Anonymous said...

I do think that you ought to seek out a lawyer experienced in these things (as somebody suggested here before). Can't hurt, and might have the effect of getting Karen to take this seriously. Nothing (except maybe being shot at) focuses the mind as effectively as hearing from a lawyer that you might be sued.

--Dad

M said...

Regarding lawyers (that have definitely been recommended by many) bear in mind that Karen at Gallagher *is* cooperating, there's nothing she could do to hurry up MinnesotaCare. MCHA's rules are their rules (and are common across the entire insurance industry), they're waiting for the letter of Termination from me. My primary need is to get surgery, and that means I need insurance, and that means I need the letter from MinnesotaCare.

If my hope is to get some financial remuneration for the hardship or the oversight, that's another situation. But in terms of actually getting the surgery done on time, there's no way that a lawyer could hep with that, short of suing the state for the termination letter, which would certainly take longer than just waiting for the letter to arrive in the next few days. So, good advice for the post-surgery timeframe, but right now I just need to get to the surgery and don't really have time to plan for post-surgery.

I *will* get the letter. I have been reassured my MCHA that they *will* cover me. But it just won't happen in time for the surgery, which means it will take 6 weeks or more to get another surgery date.

emily said...

but... but...
mayo isn't going to demand payment in full before they let you go home, are they? can't you go ahead with surgery and let the money get sorted out later?

Anonymous said...

Could you do the surgery out of pocket and get reimbursed for that as well? JL

Anonymous said...

I hate to see you cancel the surgery. Can you see if you can call and talk directly to Karen's contact at MCHA?

Mom

Anonymous said...

I agree with many of the comments so far - schedule the surgery and worry about the money part of it after. This is life or death for you, which your doctors know. And I'm still available to contact your elected officials. And there's also the press we can go to - never underestimate the power of a good news advocacy story.

Mary Rohe

M said...

Mayo has so-many self-pay patients that they have a whole business office dedicated to it on the first floor right as you walk in. Yep, they expect the entire amount, up front, before they do anything. Or, one could have insurance, of course...

All I have at the moment is a verbal assurance that I will be covered, and retroactively covered at that, if I pay out of pocket.

emily said...

goddamn.

Kevin said...

Goddamn indeed. As I said on the phone, your best option may be to pay out of pocket now and get reimbursed. You do run the risk of losing the money, but you lower the risk of dying from delaying the surgery or side effects from having someone less qualified do the surgery.

That paying $110,000 yourself is the "best" option says worlds about the quality of options available.

M said...

Legal/political/media ideas are great options if MCHA denies me, but nothing that I'm aware of will move this process any faster right now. Minnesota is one of the very best states in the country as far as offering state health insurance programs. Those who have no other choice but to use it get used to 3rd rate service, poor communication, overworked staff, a maze of rules and regulations and mountains of paperwork. MinnesotaCare works, most of the time. Is it better than nothing? Yes. But is that really the benchmark of success?

Cathy Crea said...

I agree with the others who say do the surgery, sort it out after. I have confidence it will work out. (Though it might take a while.) It sounds like you have done a good job getting assurance that it will be covered, even if you don't have all the paperwork in hand. Your doctors will be able to testify to the fact that waiting for the surgery is not a good idea.

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