But let me catch you up as to why I've become a major cranky pants that resorts to yelling at people over the phone and telling them what for. Soren was born in 2003. Like any parents of a baby, we paid for his diapers. However when it became clear that potty training wasn't going to be an option for our boy, diapering/incontinence supplies started being subsidized. Now, I'm a little fuzzy as to when this started. But according to my records, it's at least 2010. All we needed was a prescription from Soren's pediatrician. Yippee! However, our primary insurance through Aaron's work doesn't cover incontinence supplies. Boo. But Soren has "medically necessary" MediCal and they cover incontinence supplies. Like any secondary, they need a letter of denial from the primary. I have one such letter from 2011 that I keep in The Incontinence Supplies File. That letter of denial means that we've been accepted to the World of Free Diapers, Pads and Underpads. And in the expensive world of a child with disabilities, that means a lot.
A wonderful company called Shield Healthcare used to provide Soren's supplies. They'd deliver every month like clockwork. Authorizations only had to be procured once a year. And while I'm sure I'm remembering this much rosier than reality, I really do think they were awesome. Then MediCal changed stuff around and Soren's new coverage didn't work with Shield (no idea why).
A new supplier was assigned. Hoops had to be jumped through. The prescription from his pediatrician that had seen Soren since birth and new his entire medical history no longer worked anymore. That would be too logical! I had to take Soren to a MediCal doctor to prove that Soren was disabled so the doctor could sign a form saying Soren needed these supplies. Under the new system, the supplier had to get authorizations every 3 months or so. And you know what that meant? A delay in delivering diapers! Do you know what a delay in delivering diapers means? A really tense mom!
Since I was still at the beginning of this journey, I got things done quickly and made friends with a lovely VP of Operations at MediCal who gave Soren a standing authorization. The supply company just had to fax the request and the authorization would be sent right to them. Sounds simple enough right? Yeah, it does! But, sadly, it rarely was.
The first company we were assigned was okay. But they caused me enough frustration that I asked my VP of Ops if we could change companies. BIG MISTAKE. The other company was so bad I wanted to tear my eyes out. The receptionist there was rude and a brilliant liar. She would constantly tell me that our order was being delivered and when it wasn't I would call and find out that Soren's diapers had been discontinued. Well then, how could our order possibly be en route? So after a couple months of this nonsense, I begged the VP of Ops to be changed back to the original company. The good thing about this company is they were relatively consistent and, when they weren't, they were driving distance from my house so I could go pick up stuff myself.
Fast forward to years later...three weeks ago. I called to see when we'd be getting our delivery. The supply company said they'd sent the request for the authorization to the doctor and not heard back. I told them (once again) that they didn't need to send the request to the doctor. They needed to send it to directly to MediCal. I gave them the fax number. Then, since we were nearly out of diapers, I drove to the supply company and bought a bunch to cover us until this was all cleared up and we got our delivery as I'd done many times before.
You may be asking yourself, "Hey Amy, why don't you just go to the store and buy some diapers?" Well, let me tell you. We can buy Poise pads at the store (thank goodness for bad bladder control, eh ladies?) which we have done, because for some reason Soren's order does not have an even number of diapers to pads. We can even buy the underpads or "chucks" at a store. In fact, we could get those at a pet store! But we'd never need to because for some reason our order has a crazy amount of chucks. Seriously, I think I could carpet my house with them (granted, I have a small house).
But Soren is in that sweet spot where he's too big for children's diapers and too small for adult diapers. So getting them from a store is a no go. We have to get them from this supply company. And if we don't...well...things would be very messy at our house. Yet, whenever I tell the guy at the supply company that I'm coming to purchase a case of diapers, he seems surprised. "Are you sure? That will be expensive." Oh, but the alternative is so much more expensive, sir. So much more.
After picking up the diapers, being a busy mom, I forgot about the diaper delivery for a week and then called saying, "Hey, when are those supplies being delivered?" They then said they sent another form to the doctor. This is when I got cranky, telling them that they didn't need to send a form to the doctor. That I told them that a week ago. They said this was a different form. This was a yearly form and they needed it filled out. I was pretty confident these guys were wrong again. And this is when diplomacy went out the window, cause I told them that I thought they were wrong. But in the event that they weren't, which I doubted, since I'd fixed the last problem, why didn't they call me and ask for my help? Didn't they want this form filled out? Didn't they want the money for these diapers? Wouldn't it behoove them to move this forward? I told them that, as usual, I would take care of this and get things sorted out. In other words, I would do their job. Yeah, I said that to them. Again, not diplomatic of me, I know. I then tried to contact my VP of Op, but she wasn't available. So I took the next logical step and I tried to make an appointment for Soren to see the doctor.
One problem was that the supply company had sent the form to the wrong doctor. Now this wasn't entirely their fault. MediCal had switched Soren's doctor, which is something they like to do. So it was no wonder they weren't getting a response. Since Soren doesn't really see the MediCal doctor, I didn't really care what doctor we went to see. I just needed to get this done. I explained the situation with the form and the diapers to the receptionist, but they didn't have an appointment for a week. I understood. I was calling at the last minute. Beggars can't be choosers. Desperate, I was going to go purchase more diapers from the supply company that I just yelled at when the doctor's office called back. They had a cancelation. They could see Soren that day! The trouble was it would be cutting it close with when I needed to pick up Moira. But desperate for diapers, I decided to go for it!
I showed up early, filled out the medical history paperwork, and then waited. And waited. And waited. We were early, but everyone else was taking forever. Ugh. Once we got in the exam room, it was really fast. I explained the whole thing to the doctor. That we actually didn't really go to this office. We just needed him to fill out this paperwork so Soren could get his supplies. The doctor thought it was rather silly that we couldn't go to Soren's regular pediatrician, which I totally agreed with, but whatcha gonna do? The doctor filled out the form and set us free! Whoopee! (We were about 10 minutes late picking up Moira, but she survived.)
The next day I put on a big smile, took the form personally to the supply company, and picked up the diapers. Yay! Awesome! Done!
But then yesterday, a delivery guy showed up with another delivery for us. I guessed this was to make up for the almost 2 months without supplies. And since I'm never one to refuse free diapers, I was happy to see him. But then I looked and the delivery was 90% wrong! What the heck? It had pull-ups instead of diapers. Wrong. And thin pads instead of ultra pads. Wrong. I sent back the pull-ups. I didn't register the thin pads until later. Ugh.
So today I drove on down today to exchange the pads. That went smooth as silk. Then I mentioned the pull-ups/diaper mix up. Well, this sent them into a tailspin. Twenty minutes later, the first kind fellow said that the order that I picked up last week was the order I paid for. I sighed. Um, no it wasn't. "Yes it was," he insisted.
One thing that really bugs me is when people try to tell me something happened in my life that I know for a fact didn't happen. Dude, we both were there. But since you don't remember, I will take you through it step-by-step until you remember. So I did. I told him about STEP 1: The Authorization. That's when I came in and paid for the diapers. STEP 2: The Doctor's Form. That's when I brought the form in and handed it TO THIS GUY and then he PERSONALLY loaded the boxes into my car. Oh yeah!!! He remembered!!!
So this fellow disappeared for another twenty minutes or so. Next thing I knew some other guy came out saying that they couldn't fulfill the order because he just found out that Soren had primary insurance from Blue Cross and he didn't have a denial letter from Blue Cross. Okay now people, Soren has had primary insurance from Blue Cross since birth. Actually, we were covered under Blue Cross before Soren even existed. It was a pre-existing insurance!
But today, when I arrive, this guy looks on his computer and sees that a) Soren suddenly has Blue Cross and b) he's spoken to someone from Blue Cross and NO RECORDS OF DENIAL FOR THE INCONTINENCE SUPPLIES HAVE EVER EXISTED! So, because of this newfound information, he has to write Blue Cross a letter of request for said supplies. Then they have to wait for a letter of denial. And until they got that, they could not fulfill this order.
Ok, remember how I just wrote that it really bugs me when people try to tell me things happened that didn't happen? Well, by that same token, it also bugs me when people try to tell me that things are true that I know are untrue.
- As noted above, Soren has been covered by Blue Cross since forever.
- All medical entities involved with Soren's care have been told about this primary insurance. If they claim that they don't know this or are suddenly finding out about this from their computers by some sort of magic, it makes my brain hurt.
- This supplier claiming that there have been no letters of denial from Blue Cross is an absolute fallacy because...
- I knew for a fact that these letters exist because I HAD ONE IN A FILE IN MY HOUSE!!!
But I kept it together and told him what I was yelling inside my head. But it did this all in a very calm, cool, and collected voice. I told him that delivery guy showed up on my doorstep yesterday with the wrong supplies. I came there, just trying to correct their mistake. We've had Blue Cross forever. It's unfortunate that the computer system didn't indicate that. As for the letter of denial, I informed him that I was quite confident that I had one in my Incontinence Supplies Folder (I didn't want to be too cocky in case it wasn't where I thought it was) and I would happily fax it to him when I got home.
And because I did not yell or break into tears or read him the riot act, do you know what happened? Fifteen minutes later, he appeared with 2 cases of diapers! Just in case this whole approval thing took a little longer! So I got the supplies from last week AND then a full order this week!
And you know what else? That letter of denial was exactly where I thought it was! I faxed it right to the guy within ten minutes, as promised. Once again, they had a problem and I supplied the solution.
So while I am trying my very best to reinstate diplomacy, it is challenging. Especially since this supply company is perfectly situated between a police station and my favorite fried chicken restaurant, Dinah's Chicken. The real miracle is that I didn't end up in jail or with a bucket of crispy chicken all to myself.
Amy
