Last week, I noticed the “pre-approval” i received from Medica had two mistakes, about two scans I need at the Mayo. One scan is a PET scan. They had the scan right but the name of the doctor ordering the scan was wrong. As the news shows us, little mistakes with insurance companies can lead to me, or anyone, paying thousands of dollars. The second mistake was that they only pre-approved the PET scan. My doctor also requested an MRI. It was not on the letter I received, so I wanted to make sure they were going to cover it. I didn’t make these mistakes, but I could literally pay for it.
I called Medica to discuss this. The man I spoke with was helpful but too confident and determined that “everything was going to be alright.” I let him carry on for a while before i mentioned that everything was already not alright because I’m getting bills for $900 on services that were pre-approved. And by the way, I have to spend my time calling Medica to sort out big bills while I have this little cancer thing going on. How is it that Corporate-Run Healthcare is so much better than other forms?
Eventually, I told the guy on the phone that I’d like written confirmation that both my scans would be covered. He couldn’t do that, so he gave me an email address, which meant I had to explain the whole thing over again. Talking to the guy took at least a half hour. The letter below took about an hour to write. That took time out of my day, essentially doing Medica’s job for them, but that’s the time you spend when a mistake could literally cost me thousands.
The letter below is complex because cancer care is complex, and in my next post, I’ll show the reply I received, which is also complex. I honestly can’t understand why we tolerate this.
Sent: Thursday, September 14, 2017 1:58 PM
To: askmedica@medica.com
Subject: Please Confirm Coverage: Pre-approval
Hello,
I just finished a phone call with Medica customer support to clarify an authorization for out of network coverage to be paid at in-network costs. The man I spoke with at customer support was helpful, but when I asked for written confirmation, he told me to send an email message to you. The purpose of this note is to get written confirmation that I have pre-approval for in-network cost of a medical scan. The scan is a pelvic MRI that was requested from Dr. Pisansky at the Mayo Clinic.
In case it’s helpful, my Medica ID number and address are below.
ID: (removed from this blog post)
Address: (removed from this blog post)
The confirmation I’m requesting comes from a letter Medica sent me on September 11, 2017. An important part of that letter is below.
On 09/11/17 we determined that a PET Scan is eligible for coverage under your benefit plan at your in-network level. You may receive one PET Scan, provided by Manish Kohli, M.D. during the following time frame: 09/08/17 – 12/31/17.
The text above mentions a PET Scan, which I also need, but it does not mention a Pelvic MRI. The text above also mentions people and scans that are described below.
- Dr. Kohli works at the Mayo Clinic in Rochester, Minnesota. I saw him about 5 weeks ago.
- Dr. Kohli referred me to Dr. Pisansky at the Mayo Clinic. Medica has approved me for 3 visits with Dr. Pisansky. I’ve used one and will use another next week.
- The letter from Medica on 9/11/17 states that Dr. Kohli requested the upcoming PET Scan, but that’s incorrect. Dr. Pisansky requested the upcoming Choline PET scan and a pelvic MRI.
The issue I would like confirmed involves Dr. Pisansky’s request for two scans, the PET Scan and Pelvic MRI. That MRI would also be conducted at the Mayo Clinic, which is not in my Medica network.
The pelvic MRI is not mentioned in the letter from 09/11/17. The Medica representative I spoke with, a moment ago, verbally told me that the MRI would be covered at an in-network cost as a part of my pre-approved 3 visits with Dr. Pisansky, but I would like this confirmed in writing. Could you provide this confirmation with an email and paper reply?
I hope you can reply to this email message soon because my cancer is currently untreated and growing to increase the chance the scans will find it. If the Pelvic MRI is not pre-approved at an in-network cost, I will need to reconsider when the scans will occur. That would take additional time during which my cancer will continue to grow. After the scans, we will treat my cancer again, so it will stop growing.
Thank You,