Janine and Katie, you both made me laugh and brightened my day - thank you!
Yes, I agree it's ridiculous that PacifiCare has taken this long to re-approve me (they received my file from Dr. Juarez exactly one month ago today, for crying out loud!), but I've given up on "rattling bars" by calling them directly - it doesn't help and only serves to irritate me. I have spoken to different PacifiCare customer service agents no less than seven times in the last month, and have never gotten a single piece of useful information (well, one piece), much less consistent answers, out of any of them.
One told me that she wasn't allowed to give me any information at all, apparently to protect my privacy from myself. Another told me (wrongly) that I was approved, but only for a 30-day window from August 24 to September 24. Two different others told me they couldn't decipher the medical terminology to tell me what my electronic file indicated. Two others told me (correctly) that my file was still under review by the Medical Director of Prior Authorizations and to contact my surgeon for the status of the approval.
The Prior Authorizations department will only speak with providers, not patients, and I had trouble even getting a PacifiCare CSA to give me the phone number of the department (one finally did give it to me) that is apparently holding up this process, in order to allow me to find out for myself what is taking so long. I called Prior Authorizations myself, and, as the CSAs had warned me, they didn't want to speak to me because I was a member, not a provider.
I went into my explanation of why I was calling on my own behalf, and then was placed on hold for a really long time, with annoying music repeating again and again. The hold lasted so long that I placed the phone on speaker and proceeded to go about my business for about 20 minutes, rather than just sitting there with my shoulder cramping and my eyes glazing over. Finally, the Prior Authorizations rep came back on the line and told me (ta da!) that my file was in the hands of the Medical Director, that there was no other information that they could give me about its status, and that I would have to have my surgeon's office get in touch with the Medical Director.
Getting answers from my surgeon's office has not been easy either. The regular authorizations person in Dr. Juarez's office went on maternity leave last week. The person who is handling authorizations in her absence told me last Wednesday that she had just talked to PacifiCare, reminded the Prior Authorizations department that this was a re-approval with only a change in surgeon, and asked them to expedite the authorization request, since the Medical Director had had the file for almost four weeks.
She asked me to call her on Friday to see if anything had changed. When I called early on Friday afternoon, she had already left for the weekend. I left her a message at that time. I called again today, and was told that she was out of the office for the day. I left another message.
For those of you who don't already know my story and why this is becoming so frustrating, let me explain that my first approval took two working days! I had an appointment with my original surgeon (bless his heart!) on June 7, before he submitted his dictation to PacifiCare, and received word from his office that I was approved on Monday, June 11. Surgery was scheduled for July 31, but cancelled by the surgeon (bless his heart!) on July 18. I had to start the insurance approval process over again with the new surgeon in August, but was able to use all of my evals, etc. from the first approval, so I was anticipating an easy re-approval process and hoping for a surgery date in late October or November. Now I'm thinking December or January!
I am doing my best to "let go and let God" in this situation - doing as much of the "footwork" as I can do and not trying to control the outcome. I am treating this re-authorization process as an opportunity to practice patience and acceptance of the things I cannot change (saying the Serenity Prayer a lot!), and am focusing my energy on other parts of my life that are within my control, such as eating less (which has been a problem lately), going to my water cardio class at the gym and getting more exercise, and dealing with work and home projects.
It's not easy to "turn it over", but I don't really have a choice, if I want to keep some level of serenity - I can make calls every day to PacifiCare, but it does no good unless the right department will speak to me. I can call the surgeon's office every day, but it does no good if the people I need to speak with aren't there, and can't do anything to speed the process anyway. All I can do is the next right thing, whatever that may be, and know that this surgery will happen whenever it's meant to happen...
the waiting game!
Gobble-Gobble!
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