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Now that we’ve set the stage, so to speak, lets get into why this series started.
Back in February of this year, I placed an order for CPAP supplies with a provider on the preferred list with my insurance company. I’ve used them before and had no issues, so I expected this time to be more of the same.
With my insurance plan, CPAP supplies are considered durable medical equipment; the cost of which is applied to my deductible. Not a big deal, the supplies aren’t that expensive. I place an order; I pay for the order; they file a claim with my insurance; the remaining amount of my deductible to be met for the year goes down. Yay! Easy, right? Well, one would think. Seems simple. Apparently though it takes an advanced degree in applied astrophysics to even get the process started, let alone followed through to completion.
Back to placing my order. There’s a little questionnaire that they go through with you to determine what supplies that you need. I hadn’t ordered anything since January of the year before, so I needed everything-mask, tubing, filters, and a humidifier tank (or reservoir, depending on who you talk to). She asked me if I needed the humidifier tank, I said yes. I paid my money, reminded her to file the claim on my insurance even though I’d already paid it, and we finished the call. A couple of days later (they always get supplies to me super fast, which I appreciate greatly), I receive my box-o-CPAP-goodies. Really it’s like Christmas around here any time something is delivered. I get excited. So I start unpacking my supplies, only to discover that I have no humidifier tank. Grr. Ok, fine, maybe it’s on backorder or something. So I called my customer service line and talked to a rep, only to find out that when I said yes I need a humidifier tank, the rep heard nope I’m good, and didn’t order one. But hey, it’s a small, easily fixed mistake. We had been kind of chatting and laughing, so maybe she just misunderstood. Again, it’s not a big deal. Fixed it with a 5-minute phone call; eight bucks and a couple more days and I have my humidifier tank. Sweet, I’m all set with supplies, and my husband doesn’t have to hear me snore.
It should be said that I am one of those obsessive people who like to watch my insurance claims on the insurance website. I’ve had issues before with things either being filed or processed incorrectly, and it’s made me a little cautious-or paranoid, whichever you like. I tend to check my claims every week, at least once, on the website. I look at the ones that have already processed and watch for new ones after I’ve been to the doctor. A few weeks go by and it’s now March, and I realized that I haven’t seen my CPAP supply claim-for either order- show up on the website. Hmm. Well, maybe they’re just behind because it’s the beginning of the year and everyone has their flex cards again and they’re stocking up. Or something like that, whatever. I’m sure it’s understandable.
I start with a call to my insurance company. “Hey, I don’t see this claim yet and it’s usually there within a couple of days, is it just not showing, or what?” Yeah sorry, no record of a claim on that date of service for any provider.
Hmm again. Ok fine, I’ll call my supply company.
Hello XYZ Supply Company (I am purposefully not using the name of either the supply company or my insurance, in case you were wondering.), I just wanted to touch base because my insurance company doesn’t have a record of my claim so I wanted to make sure that it has been filed like I asked. ”Oh yes ma’am it has been filed; sometimes it takes 30 days or more for the insurance company to process it so you’ll just need to be patient with them and give it a few more weeks. Plus, it is deductible season, so it may take them longer than normal.”
Deductible season? Is that really a thing? I mean, I’ve heard of tax season, allergy season, football season, basketball season, other such sport season; but deductible season?? Yeah, that’s a new one for me. And a new one for everyone I talked to about it, wondering if I’m the only knucklehead who’s never heard of it. I still am not sure what she meant by deductible season; I’m waiting to find someone who’s heard of it. So if you do know anything about this deductible season, please share!
I decide to give it a little while-maybe they are just backed up. It is the beginning of the year, maybe people are stocking up. I check back on the insurance website a week later and…no claim. Sigh.
By this point, it’s been a month since I placed my order (well, orders). I’ve reached a higher level of annoyance now. Again, I’m not a patient person; so it taking this long for me to be really annoyed is pretty impressive. At least as far as I’m concerned. I call the billing department of XYZ Supply Company. And I wait on hold. Still waiting. More waiting. Finally, 40 minutes later I get a person. Come to find out that XYZ Supply Company, hearing that I want a claim filed with my insurance, it seems that they need a current prescription and notes from my doctor. Even though I specifically told them when the order was placed that I wanted a claim filed.
I am blown away. So now, a month after I placed, paid for, and received an order for what is considered ‘durable medical equipment’ the supply company needs an order from my doctor. An order they already filled. Which, if I’m understanding this correctly, means that they filled a prescription that they didn’t have. And if I understand correctly, that is a pretty big no-no.
Now I’ve had maintenance medications before that required a prescription to refill. And I’ve been told by the pharmacy (regardless of what pharmacy I used) that they are not able to fill the medication until they receive an updated prescription from the doctor. Hmm. Am I the only one who finds it a little, for lack of a better term, hinky that my order was processed in the first place? But whatever, fine. So they need a new prescription. I ask, just to make sure, if they have my doctor’s number. At which point they inform me that they’ve been fighting with my doctor’s office-specifically with Nick, about getting what they need. I’m already annoyed and now you tell me that my doctor’s office, Nick, is the problem. Fine. Nick and I will have a come-to-Jesus talk. I will fix this for you-even though getting this lined out is your job, I just want this over and done.
Cue the call to my doctor’s office. Hi, can I speak with Nick. Oh, you don’t have a Nick? Interesting (though not at all surprising, because I’m doubting everything that XYZ Supply Company tells me by now). Well, here’s my issue-blah blah long explanation, yeah it’s crazy; yeah this is what I need and who it needs to go to blah blah. XYX Supply Company says that they’ve been trying to get this from you for a while. Oh, you have no record of them contacting you, and you didn’t receive the fax request they say they sent? Shocking. Cue surprised face.
I give my doctor’s office the fax number that XYZ Supply Company gave me to send in the prescription and office visit notes. They tell me that they’ll take care of it. The lady calls me back the next day, they’ve sent in my prescription and visit notes to the company, and received fax confirmation that it was received. Yay, we’re coming up on a resolution! Yippee!! Or, not so much.
I give it another week and check again. Aaannnddd…….still no claim. Now I start doubting myself. Am I being unreasonable? Am I just being impatient? Or should this have already been resolved? Then I decide, nope. This is craziness. The last straw was when I went to the doctor and the claim for that showed up on my insurance website within 4 days-half of which was a weekend! Ridiculous.
So I call XYZ Supply Company. Again. And I wait on hold, patiently. Again. Then about 20 minutes in, the hold music stops. Dead air. Strange, but I think maybe the radio station they were using went out, or maybe there was a glitch and it just stopped. I’ll give them the benefit of the doubt. That is, until minute 38 of the call (and that is exact, I checked my phone bill) when the call disconnected. Yeah, I said DISCONNECTED.
Whiskey. Tango. Foxtrot.
It’s getting good!! But long. So we’ll break here. Come back tomorrow for more!!