AHCCCS "cares" my arse.
March 29th 2011 his Neuro-Oncologist put in for an 8 week standing order of an MRI- scheduled for tomorrow May 24th.
Apparently the insurance company -AHCCCS- decided that "8 weeks" meant 20 ish days. They cancelled/expired the order for Wash's MRI on April 16th.
Not his Doctor, his INSURANCE cancelled it.
His doctor's office told us at 4:26pm our time today - getting his paperwork ready for tomorrow someone noticed that the insurance had marked that they would not pay for his MRI (possibly the Neuro consult after as well, never heard back).
We were never notified before this time there was any problem. We were never notified by the insurance and his doctor did not notify us back in April there was a problem. Quite possibly the insurance company did not actually inform the doctor's office in April they cancelled the order. Hopefully I can find this out tomorrow.
Luckiest option is that a new order can be rushed through and approved for end of this week, and that we can get a new MRI scheduled last minute as well. Possibly he might get in to be scanned in a week or so paid by insurance.
If they drag their heels and say it won't be for two weeks or more then I will cry for a little while and figure out what to sell to pay out of pocket.
This is brain cancer. He really can't 'wait' on this one. Unlike some other cancers, this one can't be seen just everyday, or with an X-ray or Ultrasound.
Sigh.
Wash has withdrawn since then. I'm worried. I hate how someone else's shit can hurt him physically and psychologically.
What else? Hasn't he been made to suffer enough?
Another night of sleepless rest and holding my husband telling him it will all be ok and all be alright, not knowing if that is really true.
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That's so weird. I wish there was something I can help you out. I work for an imaging company who have various AHCCCS plans and depending on the plan, I can get authorizations from them for their studies and some are every 4-8 weeks.
ReplyDeleteIf you want to email me and let me know what imaging company he goes to (or you can ask me where I work)and if it's where I work, I can help you out. The company I work for is huge around the Scottsdale area.
revengeofthebooknerds@yahoo.com
I will help out as much as I can. Ask his doctor's office if they did a "Peer to Peer" with the medical director of the AHCCCS plan. 8 times out 10, that Doctor-to-Doctor conversation will get that authorization pushed through.
From March 29th - April 16th is "18 days"............ i.e., not "8 weeks"!! Hopefully, you can find out tomorrow about what went wrong (and where/why), too.
ReplyDeleteJaime (first in Comments) is absolutely right about a "Peer to Peer" Conversation between Wash's Neuro-Oncologist and the Medical Director of the AHCCCS being the best thing to do, i.e., to get that MRI Authorization pushed through. Maybe Wash's Neuro-Oncologist can also then provide the appropriate employees in AHCCCS with *her* (unequivocal!!) reasons for Wash's 8-week Standing Order for an MRI Of The Brain, too.
What I am wondering is if the office (or the facility) made the flub. In reality, an authorization from AHCCCS (depending on the plan) only takes a couple of days to obtain. If they submitted it too soon after the last MRI, they will most likely kick it back as a Peer to peer review, especially if they didn't indicate that a range of dates for a date of service.
ReplyDeleteJaime, I am calling and talking to the MRI dept at Barrow's and AHCCCS again today. My worry is they will try and back bill us for the services today.
ReplyDeleteI know that his Neuro-Onc tries to be as helpful as she can, so just have to wait and see.
Oh good, I am glad to hear that his Neuro-Onc is trying to be helpful. Oncologists and their staff tend to fight HARD for their patients. Sorry, I tend to be a little jaded with medical assistants.
ReplyDeleteOne thing, keep in mind, they can NOT bill an AHCCCS patient. So you had better NOT get billed for it. Barrow/St. Joe's should write it off. They can eat ONE MRI. Just yesterday, I had a patient that my company had to write off a brain MRI on a patient because we couldn't get the insurance to approve (a private insurance, go figure... I swear, these insurance companies made a new years resolution to deny PET Scans and other tests), BUT we made the call to get it done because this patient ALSO has an aggressive brain cancer and there was no way we were going to turn this patient away. We took a loss. Sometimes we have to, this patient needed this MRI.
If it happens again, PLEASE let me know. Please? I am sure I can ask my boss to help Wash and you out and get him his MRI, I know that Barrow's would rather keep you there as it's easier for the Neuroradiologist to read the films and do direct comparisons to all studies and for the Neuro-Onc to have access to all his films right there. But, if you have another issue, please let me know? I know I can help.
My daughter sees the Neurologists, Neuropsychologists, and Neurosurgeons at Barrow's, too, and they really are amazing. She is also at the mercy of AHCCCS. *knocks on wood* We haven't had to really deal with the crap you two deal with, only thing was getting her botox in her left arm and leg. That's not lifethreatening. Our fight has been with the Department of Developmental Disabilities. Ok... off my tangent. /end rant.
Granted, I can't promise anything but I sure as heck can try my hardest.
ReplyDeleteChin up guys. You two are going through MORE than anybody should. Life isn't being kind, but know we're rooting for you both here :)