The Insurance Game

So glad I don't have to deal with insurance companies on a regular basis!  I do as a provider often enough, and it's never straightforward.  Now I'm getting cozy with the details of being a patient in this maze of paperwork and phone calls.  It gives me a whole new perspective for my patients as well.  I already have some working understanding of it all, and its still a mess.  Some of that makes it more frustrating, having to explain to a medical reviewer why my preauthorization request should be granted.

The "second opinion" we've been referred to is out-of-network; basically we've already seen our in-network expert so anyone else will be out of network.  Talk about frustration, try the politics of referrals; I'm sure most people assume referrals are onto the next best expert.  I hate to break this news, but it is not that simple.  Need we forget healthcare is a business, and insurance is a bigger business?  Even within a group of specialists, not everyone has equal expertise further subspecialties.  It gets complicated.  But after doing a lot of research we've actually discovered one of the few IUA experts happens to be nearby.  In fact he is who my first OB/GYN wanted me to see but I couldn't then b/c of insurance; granted we didn't know at that time what the diagnosis would be, or how severe.  Ironic, sad, frustrating.  So in the meantime, we play the waiting game some more, this time with the Insurance company.