Guest guest Posted September 7, 2011 Report Share Posted September 7, 2011 JoAnn:I totally understand. If you can't figure out the system you are going to get lost in it. I finally figured out that I had to talk to a nurse directly who would shepherd my requests. If not, nothing ever happened with them. And it does take forever to get an appt. I wish you well in finding the people who will work with you to actually take care of needs and concerns. Since you folks understand the annoyances of asthma best, I'm going to complain here. Skip this one if you don't want to read whining. I've been waiting since my sleep study in June to get a referral to the pulmonologist to get a treatment plan for my asthma and severe sleep apnea. When my primary care MD finally requested it, evidently he didn't include all the information so it was denied. Today I've spent nearly 3 hours tracking down where the plan went off the track, and it sounds like the office neglected to send the test results with the pulmonologist's request so it was denied by my medical group and never did make it to my insurance company. I was so upset at one point today that I was ready to change medical groups. At the least I'll be switching primary care doctors and filing a grievance with my insurance company about it. When I called my doctor's office to make an appointment to complain about this whole mess, I can't get it for a month! I do have an HMO but it costs over $800 a month just for my coverage, so I don't think it's excessive to expect an appointment in less than a month with a Primary care MD. Even my rheumatologist can work me in is a month if I'm not picky about the time they give me. In the meantime, I just made an appointment with the pulmonologist directly. The cost is only $30. I told the gal she she had to be kidding. I can't believe they denied a $30 visit! It's past ridiculous. Thanks for letting me vent! JoAnn who is fuming in very warm Southern California at 103F (steam coming out of my ears slightly warmer!) -- Take care, Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 7, 2011 Report Share Posted September 7, 2011 Whining is allowed here. I've done some of my own. I'm ready to whine about this weather. I love the cooler part of it but not the humidity and low pressure. I'm a bit congested but hanging in there.To: asthma Sent: Wednesday, September 7, 2011 6:23 PMSubject: Re: Still no referral JoAnn:I totally understand. If you can't figure out the system you are going to get lost in it. I finally figured out that I had to talk to a nurse directly who would shepherd my requests. If not, nothing ever happened with them. And it does take forever to get an appt. I wish you well in finding the people who will work with you to actually take care of needs and concerns. Since you folks understand the annoyances of asthma best, I'm going to complain here. Skip this one if you don't want to read whining. I've been waiting since my sleep study in June to get a referral to the pulmonologist to get a treatment plan for my asthma and severe sleep apnea. When my primary care MD finally requested it, evidently he didn't include all the information so it was denied. Today I've spent nearly 3 hours tracking down where the plan went off the track, and it sounds like the office neglected to send the test results with the pulmonologist's request so it was denied by my medical group and never did make it to my insurance company. I was so upset at one point today that I was ready to change medical groups. At the least I'll be switching primary care doctors and filing a grievance with my insurance company about it. When I called my doctor's office to make an appointment to complain about this whole mess, I can't get it for a month! I do have an HMO but it costs over $800 a month just for my coverage, so I don't think it's excessive to expect an appointment in less than a month with a Primary care MD. Even my rheumatologist can work me in is a month if I'm not picky about the time they give me. In the meantime, I just made an appointment with the pulmonologist directly. The cost is only $30. I told the gal she she had to be kidding. I can't believe they denied a $30 visit! It's past ridiculous. Thanks for letting me vent! JoAnn who is fuming in very warm Southern California at 103F (steam coming out of my ears slightly warmer!) -- Take care, Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 8, 2011 Report Share Posted September 8, 2011 Today I learned that the pulmonologist requested a titration test to see if a CPAP or BiPAP would help me. Now my primary care office is going to request them if the doctor says it's OK. In the meantime the customer service folks at my Medical Group say to file a expedited grievance with my insurance since they can over rule the denial for a consult. Did everyone else who uses a BPAP or BiPAP do a titration test first? When my husband when through this process, he just bought the machine and fooled around until he found a setting that he liked based on the average setting for someone his weight. Turns out the Medical Group did have a copy of my initial sleep study, even though the phone people say they did not. The supervisor has a copy of it so it must have been sent along with the initial request for a follow up visit with my pulmonologist. I'll see him next Wednesday afternoon and see what he thinks at this point in time. Thanks for the sympathy on and off the list! JoAnn Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 8, 2011 Report Share Posted September 8, 2011 The cost to you may only be 30.00...but the insurance company will probably pay out much more. A month wait for a new doctor isnt too bad really...there is a serious shortage of doctors. When I lived in Florida before we got married, I had to wait 3 months before I could get an appointment with a doctor...even with my asthma. In some areas of the country there are patient to doctor ratios of up to 2400:1...particularly in areas like SC. Good luck with your visit...and I hope you get the answers you are looking for. Ann Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 10, 2011 Report Share Posted September 10, 2011 Well after multiple phone calls last week, the gal who does the referral paperwork spoke with a supervisor since the medical group claimed that they hadn't received all the needed papers. The supervisor said, " Well, the pulmonologist wants a titrated sleep study, so why haven't you sent in a request for that study? " I'll believe it when I see it, but evidently that may be there next step. Why they are willing to pay for another expensive test and not send for a low-cost consultation, I have no clue. I'm still planning to see the pulmonologist for cash next Wednesday to find out if this is really necessary. When my husband started using his BiPAP, he got along great with an average setting. JoAnn Quote Link to comment Share on other sites More sharing options...
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