SueG
Distinguished member
- Joined
- Sep 30, 2010
- Messages
- 213
- Reason
- PALS
- Diagnosis
- 09/2010
- Country
- US
- State
- ME
- City
- central
Glad there is a Rant & Rave page.
First, I know I am lucky to have insurance.
BUT......
they sure do like to string you along!
On Nov 16th my ins co denied a referral to the ALS clinic at Massachusetts General that my local neuro had referred me to. I immediately called, was told that the powers-that-be had determined that I didn't need to go out of state, even though there is no ALS clinic in Maine, I then called my Drs office to get them to start a reconsideration process. Meanwhile, I applied to my ins co to have a care manager. also meanwhile, a second referral that I had requested to the ALS clinic at Lahey (also in MA, I wanted to check out both options) was approved. huh?
So now it is early December, I've been to both clinics and decided MGH is a better choice for me, and I have a care manager and I ask her simply to arrange for a transfer of the approval for Lahey to approval for care at MGH. She assures me she will get back to me in a couple of days.
January 4th after several messages left on her machine, she leaves me a message telling me I need to call the main number and ask to start an appeal. In other words, having a case manager means nothing except I've been wasting my time.
I call the main number. A polite young woman named Erica assures me she understands the situation and will look into getting the referral switched, and will call me back. That's the last I hear from her.
After 10 days I call back my case manager and tell her message machine I'm sick of the run-around and need some answers. After some back-and-forth, she determines that the referral can't be switched and arranges for someone else to call me to get the appeal underway. I was almost in tears by the time I spoke to that person.
Any bets on whether the appeal paperwork she said she'd send will arrive, and when?
I am so frustrated! It's been over two months!
And this is only the beginning.........
First, I know I am lucky to have insurance.
BUT......
they sure do like to string you along!
On Nov 16th my ins co denied a referral to the ALS clinic at Massachusetts General that my local neuro had referred me to. I immediately called, was told that the powers-that-be had determined that I didn't need to go out of state, even though there is no ALS clinic in Maine, I then called my Drs office to get them to start a reconsideration process. Meanwhile, I applied to my ins co to have a care manager. also meanwhile, a second referral that I had requested to the ALS clinic at Lahey (also in MA, I wanted to check out both options) was approved. huh?
So now it is early December, I've been to both clinics and decided MGH is a better choice for me, and I have a care manager and I ask her simply to arrange for a transfer of the approval for Lahey to approval for care at MGH. She assures me she will get back to me in a couple of days.
January 4th after several messages left on her machine, she leaves me a message telling me I need to call the main number and ask to start an appeal. In other words, having a case manager means nothing except I've been wasting my time.
I call the main number. A polite young woman named Erica assures me she understands the situation and will look into getting the referral switched, and will call me back. That's the last I hear from her.
After 10 days I call back my case manager and tell her message machine I'm sick of the run-around and need some answers. After some back-and-forth, she determines that the referral can't be switched and arranges for someone else to call me to get the appeal underway. I was almost in tears by the time I spoke to that person.
Any bets on whether the appeal paperwork she said she'd send will arrive, and when?
I am so frustrated! It's been over two months!
And this is only the beginning.........