Blessed and Angry

For about a month now I've been trying to get in to see a massage therapist under my health care plan. Pregnancy and the growth that occurs with it has not agreed with me. My back will spasm just for the heck of it on a short walk, while sitting at my desk - any time it feels like it really. It's not such a great feeling. Sure it is not the worst pain I've ever experienced but it is frequent enough and I imagine only going to get worse as my front load grows ever larger that I would like to have some sort of intervention since drugs are obviously out of the question.

Hence I contacted my insurance company and was Delighted (I was so delighted it called for a capital 'D') to learn massage therapy was covered. Then I was pleased to learn my midwife could make the referral which would save me the hassle of calling my primary's office and leaving a message for her who would leave a message for the referral coordinator to make the referral. I just had to call my midwife or shoot her an e-mail and wa-lah - massage therapy benefits are activated! A week later I see my midwife who is stumped, as is the office staff, at PacifiCare. They were told on one phone call that the midwife can not make the referral that only the primary can. One another call they were told that I didn't have coverage for that benefit. So I said to not worry about it, I would just call my primary's office and make the request.

Request goes in. A week later I receive a notice that the referral has been generated and is to a Massage Therapist in Burien, not West Seattle as I had requested and it had a curious stamp on it that said pre-authorization was not required (red flag - but I'll get to that later); the referral was for the same person who worked in a clinic that had two locations. I called PacifiCare to make sure I could see the SAME provider at the SAME clinic but at the West Seattle branch. No, that was just not acceptable. The doctor would have to submit a new referral for the West Seattle clinic, never mind it is the same clinic! I called two more times and asked the same question and got a different answer. Two of the three people told me I could go to either clinic so I wrote down each of their names, the date and time I called just so I have some back up if all three were wrong and PacifiCare tries to be shysters about paying. I also learned on that call that PacifiCare didn't receive the referral but that it takes up to 10 days for it to be processed. So I wait a week and call back but in the mean time I called my primary's office to make sure the referral was sent to PacifiCare. The receptionist at my primary's office assured me it had been sent.

Monday rolls around and I call PacifiCare after waiting a sufficient amount of time for the paper work to be processed. They still had not received the referral. Lame. I called my primary's office and leave a message for the referral coordinator telling her that PacifiCare needs the referral. Tuesday afternoon I call the referral coordinator and leave another message asking her to return yesterday's call. She called back after a few hours to tell me she didn't send the referral to PacifiCare because they never require pre-authorization for Massage Therapy. Great. I'm the one exception to the rule. I told her the last person I talked to heaved out our benefits manual and read to me the part about needing pre-authorization. Referral Coordinator apologized and said she would call PC and get it taken care of. Goodie.

This morning RC calls. PacifiCare told her to contact the ASHS group of alternative health care providers to submit the request. ASHS then tells RC that their contract with PC ended June 30th (even I knew that). Jackasses, the whole lot of them at PC! Through the magic of the Internet I found the phone number for the newly contracted group of Alternative Health Care Providers and give it to the RC who by the way earns every cent of her wage because she has to deal with insurance companies and the drones they hire.

Receive a call a few hours later from RC. No referral is needed. Not from the doctor, not from the Massage Therapist and no pre-authorization is required. PacifiCare does not enter the loop until AFTER the first visit with the MT! You've got to be freakin' kidding me!!! It took a month to get to that answer?! And, I just found out that the MT has to contact PC after the first visit to get pre-authorization for continuing visits.

Then I got to start the wonderful journey of finding a provider in Seattle who was in the American Chiropractic Network that accepted PacifiCare that provided prenatal massage that had hours I could work with.

Being the dork that I am and growing ever more so into one thanks to Ryan, I did my new favorite thing and made an excel spreadsheet. Watch out folks, April knows how to have a good time! On said spreadsheet I put in all of the providers and make room for their hours. Everyone was regular business hours. Then something glorious happened... a provider offered appointments until 8pm! I was so excited I said, "No! 8pm? That's great! What do you have this Friday evening?" "By the way, I have PacifiCare." The whole group dumped PacifiCare last year! PacifiCare is such a pain in the proverbial posterior that the providers dump them. No one has gotten around to taking their name off the approved provider list. It was so sad I almost cried.

Fortunately I found someone who is willing to stay late and see me after work but she can't squeeze me in for 2 more weeks. Do I go during work and go through the hassle of finding someone to cover my shift for an hour and a half or suffer for 2 more weeks?

I pretty well covered the angry part, so much hassle for a service we pay for, now the blessed part. I remember the day back in college when I was on my parent's insurance that covered major medical illnesses that was only good if you were hit by a car or had a brain tumor. The blessed part is pretty simple and obvious. I have health insurance. Health insurance that not only covers seeing the doctor with $10 co-pays and prescription benefits but I have insurance that covers massage therapy. The whole labor and delivery and all of my prenatal visits are only going to cost us $50. $50! That's a one time co-pay. How unreal is that? Sure Ryan has to pay a portion of his insurance deductible for himself and for me - and soon little Jermaine but that's still one heck of a deal.

This may not be the most exciting read of my posts but it sure has been therapeutic writing it all down, especially when I put it in perspective at the end. It's a headache worth having.