I have a chronic condition that I see specialists for, and last year because of this, my doctor wanted me to get a shingles vaccine, because I'm far more likely to get the virus than your average person. So I went to get it last year, and it wasn't approved by my insurance company. So I had to talk to them on the phone, talk to my doctors, explained everything, it still wasn't approved. So eventually I had to file a grievance, but I had to get my doctor to file it on my behalf, and that was a whole process in its own, because the receptionists were pretty incompetent and either forgot to do it, or didn't file it correctly. I had 2 appeals rejected. Fast forward 2 months from my very first call to that insurance company, and I'm on my 3rd and final appeal. I had to go on a conference call with a team of higher ups from the company and they would only approve it if I got a written letter from my doctor, which I did. So it was finally approved.
The vaccine is a series of two shots. You have to get both. I was told by my insurance company that it covers both. They even told me "of course it covers both" because you need both for it to work. So I got my first shot last summer. I saw my specialist a couple months ago and he reminded me to get my 2nd shot, it's really important, but I couldn't because there's a massive manufacturer's shortage and there's long waiting lists across the country. You're not supposed to get it longer than 6 months out from your first shot, but there's nothing I could do, I had to wait, I'm 7 months removed now. They finally got the 2nd shot for me in this week, and I went to get it and.... not approved. My pharmacist called the insurance company with me there and they refused to approve it and let me get the shot. The pharmacist told me he did all he could do, I have to come in within a week or he has to give my shot to the next person on the waiting list, it's a massive list of almost 100.
So I get home and call the insurance company myself and they told me I have to go through the whole grievance and appeals process all over again... which like I said originally took 2 MONTHS! I don't have that kinda time, my doctor has been bugging me to get this shot, and I have a week before he gives it to someone else, and then I have to wait until the next shipment, which per my pharmacist is usually 2-3 months. By then it'll be too late.
Now here's the shady part. The person on the phone at the insurance company told me they have no record of my original appeal being approved. "Coincidentally" their systems have everything BUT that. I feel that is no coincidence. She read to me everything they have in their systems, and hilariously, it stops right before it got approved. She said they have no record of it, all they have is it being rejected. I told her, miss, I have the approval letter right here in my hands. YOU HAVE BEEN APPROVED. Do you want me to read it to you? She said it doesn't matter, she needs documentation in their system for it to actually work.
So here I am basically. I have to get this all sorted out through appeals by next Friday or I can't get it. My doctor was annoyed the first time that I had to go through all this, I know he's going to be livid(at them) when I tell him if I have to go through it again. If I can't get it sorted by the end of next week, I'm thinking about filing some kind of a lawsuit if that's the best course of action. What a joke.
The vaccine is a series of two shots. You have to get both. I was told by my insurance company that it covers both. They even told me "of course it covers both" because you need both for it to work. So I got my first shot last summer. I saw my specialist a couple months ago and he reminded me to get my 2nd shot, it's really important, but I couldn't because there's a massive manufacturer's shortage and there's long waiting lists across the country. You're not supposed to get it longer than 6 months out from your first shot, but there's nothing I could do, I had to wait, I'm 7 months removed now. They finally got the 2nd shot for me in this week, and I went to get it and.... not approved. My pharmacist called the insurance company with me there and they refused to approve it and let me get the shot. The pharmacist told me he did all he could do, I have to come in within a week or he has to give my shot to the next person on the waiting list, it's a massive list of almost 100.
So I get home and call the insurance company myself and they told me I have to go through the whole grievance and appeals process all over again... which like I said originally took 2 MONTHS! I don't have that kinda time, my doctor has been bugging me to get this shot, and I have a week before he gives it to someone else, and then I have to wait until the next shipment, which per my pharmacist is usually 2-3 months. By then it'll be too late.
Now here's the shady part. The person on the phone at the insurance company told me they have no record of my original appeal being approved. "Coincidentally" their systems have everything BUT that. I feel that is no coincidence. She read to me everything they have in their systems, and hilariously, it stops right before it got approved. She said they have no record of it, all they have is it being rejected. I told her, miss, I have the approval letter right here in my hands. YOU HAVE BEEN APPROVED. Do you want me to read it to you? She said it doesn't matter, she needs documentation in their system for it to actually work.
So here I am basically. I have to get this all sorted out through appeals by next Friday or I can't get it. My doctor was annoyed the first time that I had to go through all this, I know he's going to be livid(at them) when I tell him if I have to go through it again. If I can't get it sorted by the end of next week, I'm thinking about filing some kind of a lawsuit if that's the best course of action. What a joke.
