Part of what I do at work is make insurance calls.

What does this mean?, you may ask.

The answer: it sucks out your very soul to live.

Here’s the scoop: we get a referral. The patient (usually the patient’s parents, actually) have insurance and want insurance to cover testing. That sounds reasonable, right? Well, some insurance companies have a little sheet that you fill out and fax in. Easy peasy.

But one insurance company in particular was crafted from Dante’s 11th circle of hell.

You have to CALL to get precertification for psychological testing.

Here’s a basic breakdown of what happens next:

I read the chart from cover to cover to get a “feel” for the child I will be advocating for.

I note all the “keywords” to help smooth the process, including “defiant,” “high distractibility,” “poor attention,” etc. etc. Whatever is in there. I don’t make shit up.

Then I place the call. I press ‘2′ when directed to.

I wait on hold. The soul suckage begins.

Someone comes to the phone and takes down my name, my boss’s name, tax ID number, the child’s name, their member number, all the pertinent information. The provisional diagnosis we gave. The birthday of the child. Who I am and why I am the one calling. A contact number in case of disconnect. This person is sometimes nice and sometimes evil. Sometimes they are hard to understand, speaking with a thick Brooklyn accent. Sometimes they are male, sometimes female.

Then I am given a case number and put on hold again.

Finally! A case worker picks up the phone. Now, here’s the ugly part. They tell you up front that they don’t cover educational testing. Well, that’s fine, because we do more than educational testing. They make you tell them every single test you will give. They ask about symptoms and diagnoses. They want to know why you are going to test the child. What you are looking for. What you will do with the testing. Who referred the child in the first place. How many hours of testing are you requesting.

It. Is. Exhausting.

And I don’t have all the answers! I know that; that’s why we’re testing in the first place! So I give what I can. And then I’m told that, because of the amount of hours we are requesting, the case will have to be reviewed by a psychologist and they’ll get back to us within a few days.

Always, always, these claims are denied. We don’t know why. Very occasionally, we’re given a few hours, which does help offset the cost for the parents. But that is very rare. So the parents pay out of pocket or opt for less testing, thus gleaning them less information about their child. Not an easy choice to make.

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So I made one of these ugly calls (UC) this week.

And I must’ve gotten the WORST case manager EVER. She was either BRAND NEW or she just SUCKED DONKEY BALLS, I don’t know which.

After taking all the information, she began making soft, uncomfortable mm’ing sounds. Like she was gearing up to tell me bad news, not like she was having a bowel movement over the phone.

And she stopped me and said that they don’t cover educational testing. I said I knew that.

She said that the case would have to be reviewed by the Big Psychologist. I said I KNEW THAT.

Aaaaaand … then she said that she just didn’t have enough information and she needed to speak with the EVALUATOR in order to get a better picture of what was going on.

EXCUSE ME?

1.) I AM THE EVALUATOR, at least partly (more than what my boss is going to do with the kid, at any rate. He works with them from 9:15-10:15. I work with them from 10:15 until 3:15.)
2.) I HAVE THE CHART right in front of me … what my boss is going to tell you that’s DIFFERENT than what I can tell you? NO CLUE.
3.) I have made OODLES of these calls and NEVER ONCE had my credibility called into question.

I gently, but firmly, informed her that I could tell her anything she needed to know! I told her that my boss was with clients all evening, but she could call back another day to speak with him (she said that was impossible; she didn’t know if she would be able to commit to a time)! I said that I DO part of the evaluation and that I HAD the chart and I would be HAPPY to explain to her anything she needed to know!

No, she said, nearly whining. She needed to speak with THE EVALUATOR, DR. KTHNXBYE (she totally mangled his name like 30 times, even though I corrected her each time).

So I got her number, with her extension, and told her he would call her within a few days. I can’t call back to try to get another case manager, because our referral number is already logged in with THIS case manager.

UGH UGH UGH UGH UGH.

I felt like total CRAP. Does NOTHING I do count for anything anymore?

As an added bonus, my boss was TOTALLY UNHAPPY about having to call this woman. So I HOPE HE GIVES IT TO HER. (although he’s totally non-confrontational, so maybe not)

That was a special way to spend an hour. Blah blah information information OH YOU SUCK AND I DON’T TRUST YOU wasted hour BYE.

What do you think? I’m totally over-reacting, right? I need to GET OVER IT, right?)