Grrr

[sal_amanda]

So I called Community Blue this morning about this whole claim denial.  That woman checked it out and said the issue is that Kaleida, the health organization that runs half the hospitals in Buffalo, submitted the claim through the hospital and not the specific provider, but that they'd be receiving the same notification and would likely fix it when they got it.  She basically suggested I wait and see if I get a bill from Kaleida and call back if that becomes the case.  

Feeling that the wait and see approach was stupid, I called Kaleida billing.  The guy there who sounded totally uninterested in my plight said that they only do billing through the facility and that's just how it is.  Thanks for your help.

I just called Community Blue back to tell them what Kaleida had to say.  This woman wants to know exactly who I saw there and who made the referral and did I get pre-approval for this diabetic education.  I have no idea what the nurse's name was that I saw there, but I can feel that this is not going to end well already.  

At this point in the story, I'd like to complain about how horrible their hold music is.  It's the same "soothing" song that is just played over and over and over, ad nauseum, all fricking day.

She comes back and informs that she just called the perinatal unit at Children's and the person I saw is not covered, nor is the physician that they essentially put everything under for that unit.  I'm clearly distressed at this point and trying to understand how they cover a hospital, but not the staff at that hospital, but apparently the issue is the diabetic education and no one in that unit is considered a provider for diabetic education.  She tries to politely tell me it's my fault for not checking to see if that was covered first.  

Guess I'll eventually be getting a bill from Kaleida.  I'm hoping there isn't some other letter coming telling me that something else got denied.  This isn't a huge amount (about $80), but it's not money I'm excited to be shelling out.

Comments

[flutteronby28.livejournal.com]

yeah i know what you mean
i got a bill from the hospital for almost 3,000 dollars. i almost had a heart attack. but then what set me off was i started recieving individual bills from doctors for about 300 a piece. so i basically got billed twice for the same service? and dont the dr's get paid by the hospital too? wtf. its the most infuriating system on earth.

[sal_amanda]

Which hospital did you end up going to for that?

dont forget to flush...

[(Anonymous)]

Ah yes, the great American health insurance fiasco. You pay into it every paycheck, however when you actually have to utilize it for something one must jump through every conceivable hoop, or get all blurry eyed going over those damned listings for a health care provider that is "covered" in the policy. The truth in all this is the only thing these duche-bags want you to fill out is either a check or dig down deep for CA$H! The rugrat is still in the oven..buckle up cuz the ride gets even wilder! i.e. pediatricians, dentists, ect...and yet more fun with the insurance system.

[i-am-solid.livejournal.com]

So before anyone comes anywhere near you at the hospital, you'll have to say "Whoa there Buddy! Have you been pre-approved by Community Blue to get even remotely close to my coochie? You're not going to bill me for this conversation are you?"

[sal_amanda]

I suppose I should print up the approved list of providers to take with me so I can double check everyone.