Tuesday, May 27, 2008

Talk about your bad day!!!!

Bad, frustrating day! I haven't had one of these in a REALLY long time, so I guess I'm due. It all started with a trip to Physical Therapy. Maryam's therapist told me that she sees signs and symptoms of Cerebral Palsy in Maryam. She said that she's not diagnosing that she just wants me to be aware. She also told me that when I first brought Maryam in that she really thought it at the time, but since Maryam responded so well to therapy and is catching on so quickly that she no longer thinks its as severe as she once thought. Hopefully the longer Maryam is in therapy, the more she'll learn to use her muscles properly and all the signs and symptoms the therapist sees will just go away. Here's to hoping and praying.
Then the real drama starts. I got a phone call from Apria (the company that delivers Maryam's oxygen) and the really nice man on the other line asks me what would be a good time tomorrow to come pick up all of the oxygen and equipment. Excuse me, what? He proceeds to tell me that Kaiser says they're not covering it anymore because we're "out of area." Whatever that means! He gives me the number to customer service, gives me the customer service manager's name and phone number and I proceed to call her. I get her voice mail, of course. After that I decided to call DME (durable medical equipment) because they're the people that order the oxygen through Apria. DME is who sends us Maryam's formula, syringes, feeding pump bags, nasal cannulas, tape, bandages, tubes, buttons you get the point. I proceeded to tell Maria (She was kind of mean) what the Apria guy told me. She then tells me that Kaiser says that we're "out of area" and I don't have "out of area coverage" so they can no longer send us any of her equipment anymore.
I then explain to her that I made all of the arrangements for the transfer from San Diego to Fontana back in August and up until we had no problems getting any of her equipment, oxygen or other wise. She tells me she's going to check the records and puts me on hold. She comes back 10 minutes later only to tell me that they had erred on their side and that they shouldn't have been sending her any of the equipment all this time! So, then I explain how before we moved here I had called Kaiser to verify that we would have coverage here, that member services told me that our DME would come from Fontana, we could use Rite Aid in town, that we'd get oxygen from Apria in Palm Desert and they even gave me a list of docs that would take Kaiser coverage in town and Yucca Valley.
She puts me on hold again for another 15 minutes. She comes back to tell me that her supervisor is going to do some research and call me back in a half hour. Well, a half hour turns into an hour and a half! GREAT! In the mean time I tried calling member services only to get a recording that says 'they're too busy to call back later.' Not a please hold for the next available agent, not leave a message, but CALL BACK! OMG!
FINALLY an hour and a half later Maria calls me back only to tell me that her supervisor is researching the issue and will call me tomorrow. I take that as code for "this is taking longer than we thought, its time for us to go home, we'll start again tomorrow and call you back when we get a chance."
By this time I'm livid and I have to feed Maryam, which is taxing in itself. I decided to delegate. I had Brett try calling member services to see if they can tell us why Apria is telling me that Kaiser isn't paying for oxygen and why DME is telling us that they're not sending us anymore supplies. I gave Brett and list of questions to ask, a list of points to make, the phone number and tell him to let me know what they say. He calls me back and tells me that Kaiser says they're still paying for the oxygen because its covered under our plan (damn right! At $548/month it better still be covered) and that DME in Fontana is wrong, they are the ones who cover 29 Palms and yes all of Maryam's supplies are still being covered by Kaiser as well. She also said that she thinks there is some sort of glitch in the communication between Kaiser and Apria or that the prescription for the oxygen went to the wrong Apria office. She said that could possibly be the reason they think we're out of area. BUT, by then it was too late to talk to anyone at Apria who counts, and DME was closed. She left messages with managers at both and is going to call Brett back tomorrow after all is sorted out.
Talk about unnecessary stress! Well, I'm still going to stress about it until I hear from Apria that they're not coming for the oxygen and I don't have to pay for it if we keep it. I have NO idea how much oxygen costs! And until I hear from DME in Fontana that they're going to continue sending Maryam her medical supplies.
Its been a long day. Maryam had OT in Palm Springs at 10am then PT in 29 at 12:45 and then I spent the rest of the day on the phone. I had bouts of anger, sadness, frustration and exhaustion. Needless to say I can't wait until midnight. It will be nice to start a new day.

2 comments:

Leanne said...

Sorry girl!! Hopefully Kaiser is right. Have a better day today!

Sarah said...

I know this is terrible, but this happened to us once and I said if they showed up and took our equipment then they would have to start paying for a very long tertiary care center or they would be responsible for the death of my child. It got straightened out pretty quick. Do you have a case manager?