Monday, November 2, 2009


Hello ladies,

I got up this morning ready for war! I packed up the urns, my grievance letter, and pictures and headed to work. I had decided yesterday that I was going to speak to V.ista before heading down there. I called again this morning and was transferred to someone else (I dislike getting the run around). She saw in her notes that Kay said to transfer me when I called in. Unfortunately she was helping another client. The lady that I spoke to said that the only reason that they would deny such a medically necessary procedure was if the Dr. did not submit enough information. I asked her if there was anything she recommended and she suggested asking the Dr. to call the medical director at V.ista. I already knew this, because Jess had given me some great advice - THANKS JESS!!!).
I then called Dr. D. and left a message for him to call me back.

Luckily, I had a very light class load today (3 grade levels had field trips - thus, I only had one class and was just catching up on paperwork, grading papers, doing Individualized Education Plans, etc.) and could have my phone on.

K called me back around 12:30 to let me know she had not forgotten me. Again, I asked her if there was anything I could do on my end, and she said no. She is trying to avoid me having to file a grievance which takes months to resolve. She asked for the procedure code, Dr.'s name, and name of the procedure. She did some digging and found no notes in her database showing that the procedure was denied or even submitted. I am completely baffled!

She asked for Dr. D's contact info and said she would call him. When she learned he was out of network, she said that could be a reason. Apparently, he cannot request authorization as he is out of network. My Primary Care Dr. has to be the one request authorization for Dr. D. to do the procedure. Please remember, that I knew all this from speaking to the V.ista months before. the reason why Dr. D submitted the request was because the lady in my Dr.'s office had no clue. Hopefully when K calls them, she is able to point them in the right direction. She promises to call the Dr.'s office as soon as they open (they have lunch from 12-2).
So for now, I wait and hold off on paying V.ista a visit. Wish me luck ladies!

This weekend while cleaning (I do my best thinking then), I thought about going to the media. On our local News Station, there is a segment known as Help Me Howard. Howard, features stories on individuals and helps to find solutions. Usually, companies highlighted, do not like the negative publicity and usually comply with the individuals needs.
I was actually thinking that this would make a great "sob story". "Poor teacher that works with special needs students, lost two babies and cannot afford to pay out of pocket for a necessary procedure, and insurance is refusing to pay". What a great story that would be! Prayerfully, It won't have to come to that.

I will keep you all posted.

Where is my expected end?


  1. I think you told me at one point you were on an HMO and honestly I forgot that piece. That makes perfect sense that your pcp needs to request the OON authorization. We require that as well. I am glad to hear Kay is stepping in for you. That is excellent customer service and from a customer service rep, you may want to praise her to her supervisor when all is said and done. Let me know if you need anything else. I am here for you sista!! :)

  2. Well...that was an interesting turn of events!! I hope they figure this out...SOON!!! Good luck!!!

  3. I hope that it all works out and you won't have to go to the news station but if it comes to that they better pick you!!!