If you’ve been wondering why I hadn’t updated this blog sooner, here is a clue: I’m dusting myself all over again.
What happened was, on the evening of the day after Christmas 2017, I was involved in a traffic accident in a busy Southern Orange County road. It was a car-versus-pedestrian kind of collision. Yup. I was the pedestrian in that conflict.
I was cautiously crossing the major road, the green light in my favor, when suddenly a formidable object, which turned out to be a Grand Marquis, swiped my back left shoulder and tossed me like a rag doll. Hey, I’m only a svelte 112-pound senior babe. I thought, OMG I have been hit! Next thing I knew I was in a cobra yoga position, raising my bloody face from the hard asphalt pavement, determined to get the culprit’s license plate number in case the accident was a hit-and-run situation. It happens when the blogger has seen too many True Crime TV stories. And then it dawned on me: This is absolutely amazing, quite incredible, and super fortunate. I have my wits! I live to tell the tale! I was shocked.
An ambulance ride ensued. Later the sheriff interviewed the driver, who did not hit and run, a witness, and me. It became abundantly clear that the accident was a liability issue against the driver. According to my research later, the insured driver is a US doctor of Middle East origin. Why can’t I stay away from doctors?
I’d like to tell the story in excruciating detail but it is best to keep my mouth shut while lawyers from both sides are hashing things out.
Thank you for your interest. I’ll keep you posted.
The SECOND payment denial by the Insurance Company (IC) hovered like a dark cloud over my head. The new 60-day appeal filing period had just begun and the sense of urgency had not yet grabbed my attention. If the dark cloud meant rain, I felt like I could do a hippy hippy shake speed walk and still have time to find me an awning that would save me from being drenched. Of course I did not know how much money I was supposed to spring if I eventually lost the appeal. Maybe if I knew, I’d be flying! But paying for something that I shouldn’t is not an option. Failure to prevail is not an option.
Two weeks passed and I decided I had lived dangerously long enough. It was time to rattle Dr Brevity’s RN. I went on a messaging spree with the RN through the Patient’s Portal. Okay, that’s grossly exaggerated. I fired exactly 2 messages in a row over a span of 2 days. Exaggeration happens when the Patient/Blogger suddenly forgets her coolness and magnifies everything.
My first message read: I received IC’s Notice of SECOND denial of payment based on the information provided by you. I agree with you that your submittal was responsive to IC’s requirement to reverse the denial. Now the new and improved reason for denial was “When you enrolled in a Medicare Advantage Plan, you selected a Primary Care Physician to coordinate/authorize your medical care. The services received were not authorized and not payable by Monarch.” Please continue to represent me to Monarch.
I did not receive a response. I sent another message.
My second message read: Please let me know what action you intend to take. IC gave me another 60 days to appeal the SECOND denial. I don’t want to lose that opportunity.
I still did not receive a response. The following day, I gave up being Ms Nice Guy. I reached for the phone. After all sorts of mysterious phone connection motions at Club Med, RN and I finally found our voices.
RN: Celia what do you need?
Me: Did you get my messages at the Patient’s Portal?
RN: No I did not.
Me: The long and short is, I got a Notice of SECOND denial of payment. All I want to know is if your office intends to continue to represent me.
RN: We already gave IC what they needed.
Me: In other words, your office is through helping me.
RN: There’s nothing more we can do, but I can call Guardant and ask for Patient Claim Assistance.
While we were talking, she found my messages. She did not see them because she had not turned on her computer since her return from vacation.
Anyway, I thanked her for everything she had done to help me and proceeded to call the number that Guardant gave me if I needed help in filing the claim. The phone rang.
Voice on the other end: How can I help you?
Me: Please connect me to Client Services.
Voice: This is Client Services.
Me: Oh, you are Client Services. My contagious laughter roared.
Voice: (Laughing, from contamination). Yes I am.
Me: I need help to file a claim.
She asked for identification, date of birth, yada yada.
Voice: OK I found your case file. We received the same Notice that you received. I’m glad you called. But first I want you to know that win or lose the appeal, there is a fixed fee you must pay.
I felt my hackles kind of lift from the back of my neck.
Me: How much?
Voice: 60 dollars
Me: Come again please. I want to be sure you did not say 6K dollars.
Voice: 60 dollars
I laughed. And she laughed.
The appeal is supposed to be a lengthy process. I hope everybody lives long enough to see the end of it.
(to be continued)
Is there any experience out there like this? I’d appreciate input.
First, I’d like to thank those who offered to help me with the posting of photos in the pages of my blog. I really appreciate the responses that I got through the post, email, and Facebook.
So based on my understanding of the process, I posted the first blog update that would contain a photo: Ever Wondered How it Feels to Wear String Bikini? As soon as I opened the published post, color drained from my face. It was embarrassing! I saw a paragraph giving a warning about what might be an offensive photo at the end of the story and the photo itself near the warning! It happens when a former hot shot is determined to tackle modern technology.
Anyway, being the self-proclaimed “la gran senora” of positive thinking, I declare that it can only get better from that post forward.