It Just Gets Worse

If you think it was bad with my insurance company the other day, it only gets worse. If you care, here are the details…

I was on the phone with my insurance company most of the day again yesterday. On the 19th, I’d filed a grievance. On the 20th, they re-routed my referral to an in-network surgeon that, in 2016, had disciplinary charges filed on him by the medical board for gross negligence. Plus, if you saw the pictures on his website, I don’t know why anyone would pick him as a surgeon. He’s a butcher. 

So I had to fax the insurance company those medical board charges to show them why I won’t even have a consultation with him. Then I made sure the original referral to Dr. Mosser was denied so I could at least appeal it. They do this shit–re-route the referral so people can’t even appeal. 

So that’s what I did. I got them to officially deny it so I could file an appeal. 

Then yesterday, I found out that neither the grievance nor the appeal was filed at all. Both the routing numbers they gave me suddenly don’t exist. I had to file a new grievance, which I did online. I tried to do it over the phone, but got cut off because I had another consultation with the Gender Confirmation Center (that’s Dr. Mosser’s office) about making doubly sure I could get the incision marks I am looking for. And, yes, I can. I’m not crazy.

I also got an estimate if I pay out-of-pocket there: $10,600. That doesn’t include the $4000 it will cost for the trip.

Another thing is that I don’t have access to the denial letter from the insurance company. Why? I don’t know! Someone in the dispatch department read it to me, and the three reasons for the denial had nothing to do with Dr. Mosser being out-of-network! They had to do with things not even based in reality. Reason one: I don’t have an existing medical relationship with Dr. Mosser’s office. Wrong. I do. I’ve had two consultations Two: They won’t do a contract with my insurance company. Wrong. That fact was stated in the original referral. Three: (the most ridiculous): I don’t have a diagnosis for gender dysphoria. WTF?! That was established from the very beginning! And if that were true, why would they re-route the authorization to any surgeon at all? Are they on drugs?

So anyway, I mailed in all my paperwork for the appeal and used their bogus routing numbers. I have nothing else to go on. Today, I will ask for a supervisor in the appeals department to see what else I can do. I can only hope that these “routing numbers” just didn’t get filed yet, and the routing numbers still mean something. No idea. Why would they give them to me after going through 45 minutes of the processes?

Okay, well, I also have a consultation in San Diego with Dr. Champaneria. He is a good surgeon but he does not take my insurance. He would be an out-of-pocket situation, but there’s be no $4000 trip. I also don’t know if he would be able to give me straight scars. I have to see him first to know if he’s a back-up option and what he will charge me. I see him on February 3rd. Maybe I can make some kind of decision by then? If I want to wait out the appeals process or just pay with a credit card. I mean, is all this insanity, my sanity, worth it? I still don’t know.

The appeal process with my insurance company (if it is in fact underway) will take 32 business days. In the end, there’s still no guarantee I would be approved. It doesn’t seem likely. I could wait all that time and still be sorely disappointed. I may not make it through. 

If approved, I’d have to wait out even more time for all the testing and scheduling and still be out about $4000 for the trip to San Francisco. It’s all a big risk. So, in reality (IF DR. CHAMPANERIA GIVES ME WHAT I WANT), we’re possibly talking roughly 6000 dollars more for my mental health.

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5 thoughts on “It Just Gets Worse

  1. cindyschnackel January 22, 2021 / 12:48 pm

    OMG, so frustrating! The lack of communication, and the incompetence, between these entities is mind boggling. Or maybe it is deliberate stonewalling. I hope you eventually work through it all.

  2. Carol Es January 22, 2021 / 2:20 pm

    Thank you. I hope so too. I got their denial letter today and there’s a clause in there that says I would have had to have an existing relationship with the doctor in SF BEFORE I enrolled in the insurance program. What kind of bullshit is that?

  3. lindacbugg January 26, 2021 / 4:50 pm

    Yeah–it’s a state law about Continuity of Care because when the ACA went into effect people were concerned about losing their Dr so this was the work-around.

    • lindacbugg January 26, 2021 / 4:51 pm

      Not that this arcane piece of information makes you feel any better 🙁

      • Carol Es January 28, 2021 / 11:42 am

        No, but it’s nice to know someone else has run into it before.

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