Sunday, February 7, 2010

The Plot Thickens

My goodness! You all don't know how long I have been trying to post. No, blogger was not acting up, I just could no find a minute to sit down and start a post. Finally, after grading a multitude of papers, doing a couple of Individualized Education Plans, and sitting on my butt for 12 hours getting my hair braided, I finally have a minute.

Remember how I told you all, that I did not like B.arbara, the office manager from Dr. Char.les' office? How she seemed odd and untrustworthy? Well my distrust has magnified.
On Thursday (yes, that's how long I have been trying to get a minute), a young lady from Dr. Char.les' office called me to ask when I am going to make the $2500 payment. To which I replied, "I obviously cannot get down there today since I am still at work, Its now 4:15 and you close at 5, and you are a hour and a half away from me". She then went on to say other things, but I could not understand her (she had a strong accent), so I asked to speak to someone else. Well guess who comes on the phone? B.arbara herself! This is how the conversation went (fyi - I wrote down all her responses just to make sure I had the right info to relay to the insurance company).

Me - hello B.arbara, this is Mrs. R-W. Have you heard anything from the insurance company?
B. - Not really.
Me - You have not heard from them at all? Because the director has been in contact with me and wants to know what I gave decided.
B. - Well we don't take that as payment.
Me - Have you heard from them?
B. - Well, I have an authorization number.
Me - What does that mean? Does that mean its approved?
B. - No. it only means that they acknowledge that the procedure is being done and are aware of it.
Me - huh? What does that mean?
B. - It means that they know it is being done. Not that they are going to pay, but don't worry, I already started compiling paperwork for you to fight them to get your money back.
Me - Sorry if I sound naive, but that makes no sense to me. I refuse to give you $2500 without knowing if my insurance company will pay so that I can be reimbursed.
B. - Oh, I understand what you mean, I have 6 children myself.
Me - Well I am going to call V.ista myself, because I am not giving up my money without some guarantee.
B. - I am interested to know what will happen, because V.ista has never paid for this procedure because they view it as infertility, and they are not familiar with it.
Me - Well, I have the directors number and I will call you back tomorrow.

I got off the phone and called M., one of the directors that I had gotten the number for, all the while praying that she was still there as it was about 4:30. Thankfully she was there and remembered who I was.
She pulled up my file and I relayed the conversation that I had with B.arbara to her.
When I mentioned that I had to pay $2500 and then fight with V.ista to get my money back, her response was; "WHAT?"
To put it bluntly, she has never heard of anyone paying the full cost up front and had to fight to get reimbursed. She said that the authorization that B.arbara submitted was authorization for payment, and that they will get paid when the procedure is complete. I should not have to put money down or fight to get my money back. I then told her why B.arbara said V.ista won't pay because they consider it infertility. Well, M. said it was not coded as infertility.
To spare you the specifics, M. is turning over the file to the customer relations department to investigate, because it sounds "fishy". She said in all her years, she has never seen anyone pay the cost up front for any procedure. She will call me Monday to let me know the conclusion.

I have to say, I did not expect that response. I would have preferred if she had said, "you know Marie, that's the procedure for some places", but for her to scream "WHAT?!" just confirmed my suspicions. Truthfully, I am content with whatever decision that is made. If nothing gets solved, I am going to let her know that I am not comfortable doing it with them doing the procedure and asks if it can be approved to be done with Dr. D. Whatever way it works out, I am accepting it as God's will.
Please bring the situation with us to the Lord in prayer, that his will be done throughout this mess.

Don't forget to help me reach my goal by sponsoring me for March of Dimes. To those of you who have already donated, I thank you from the bottom of my heart. Even if you can only give $1, that means the world to me. Let us work to end PTL, stillbirths and infant death.

Awaiting my expected end?


  1. woe...thats crazy!
    I'm thinking about you my friend

  2. That is crazy! praying for you, that everything works out.

  3. What a crazy lady....I would be very concerned and definately not trust that gal. Praying for you. *hugs*

  4. Good grief....what on earth??? I am so glad your woman's intuition kicked in and you didn't fork over that cash! Hopefully they will get to the bottom of this...I'm so sorry you have to work with such shady people!

  5. That's crazy! I hope everything works out for you. xxx

  6. That does sound "fishy"...So proud of you for sticking up for yourself and for not letting people get stuff over on you! Not much longer now until surgery day!

  7. Marie,

    Sorry you had to encounter all this jibberish with Bab's the insurance gal. I find all of the insurance non-sense to be completely exhausting! My hubby keeps his own spreadsheet of all the charges, gets all the codes himself and does all the leg work to make sure we are charged correctly. Lots of work for him, but he refuses to get jiped or taken advantage of. Glad you are looking out for yourself :)

    On a happy your hair looks pretty :)


  8. Wow, I am so sorry you are going through so much for this procedure. That definitely sounds fishy! Hoping and praying that all turns out well. xx

  9. Marie, wow. I'll be praying for God's will to be done in this situation. It has been such a long fight for you, but you are faithful and God blesses his people. Much love!