May I just start this post off with a “iq4yt8f7ady6v87viuh24o8tyg86GUFDGUYOF6B@#$%^ytytr%^&*uuyf&”. Okay. Thanks.
Now, on to the story.
Last week we finally seemed to have made some progress in finally getting the Dexcom for Ang. Meaning, I spoke with some other people at Edgepark and they were able to finally manually fax the papers to the endo’s office and… *gasp* the endo’s office received them! Twice, even! Of course, what was faxed was supposedly a cover sheet the contained the real reason for the fax – which were the item codes that are supposed to be electronically submitted to the insurance for the prior authorization. And apparently the second page of the fax (incidentally the only page that wasn’t the cover page) was a “Doctor’s Orders” type page. Well, the endo filled out the dr’s orders and faxed it back to Edgepark on Thursday. On Friday I get a call from our Edgepark rep letting me know they received said dr’s orders, but that they already had them from when they were forwarded from Dexcom three weeks ago.
Of course, that made me wonder why they would have faxed a blank dr’s orders page in the first place if they didn’t need it. I chalk it up to people not knowing what the eff they are doing, which seems to be the order of things with this whole ordeal. Of course, the endo is only in the office on Thursdays so any additional thing I need from her was not happening. So I asked edgepark rep “What do you need? What was faxed that needed to be filled out if not that?” And her response was quite epic. “There isn’t any more paperwork that we need. We are waiting for the insurance authorization. The dr has to submit the dx code and item codes to the insurance to get the authorization and then the insurance will notify us that it has been authorized. The codes should be, most likely, submitted electronically through the dr’s office directly to the insurance to get the authorization. The codes are listed on the cover sheet of the fax that was sent.” DOH! *facepalm* All this time wasted waiting for some stupid fax, when it’s not even necessarily needed.
So, I ask Edgepark rep “Can you please call the endo’s office and tell them that? The nurse’s name is _____.”
EPR: “I tried calling and spoke with ________ who said she would transfer me but I get getting a voicemail and have not received a return call.”
Me: “Okay. You need to speak with _____. I will also try calling her to tell her what you just told me that the codes need to be submitted and dr shouldn’t even need to do anything.”
EPR: “Okay, I will also try calling her again today as well.”
Me: *Calls endo’s office to speak with _____.*
Me: “Hi, I need to speak with ____ regarding XYZ thing I have already told you about the last 12 times I’ve called in the past 2 weeks.”
Receptionist: “Okay. Please hold.” *hold music* “Hi, Jessica, I also have _____ from Edgepark on the other line for the nurse. The nurse says she wants to speak with you first then she will speak with Edgepark rep.”
Me: “Okay, great!” *transferred* “Hi, _____, I spoke with Edgepark and was told that you just need to submit codes to insurance for auth, no fax needed, although codes were supposed to be on cover sheet of fax that was sent earlier this week.”
Nurse: “We did get those faxes and the dr filled them out yesterday and sent them back.”
Me: “Yes, I know, she emailed me. The problem is is that was not the insurance auth, that was the RX, which edgepark already had. This is different. Codes need to be submitted electronically. _____ from Edgepark is on the other line and that is what she just told me. She will tell you about it.”
Nurse: “Okay, I will talk to her and we will get everything straightened out.”
Later that afternoon….
Me: *gets phone call while at Ang’s therapy appt* (Always seems they want to call me at Ang’s therapy appt at 3:30pm on Friday afternoon when you know nothing is going to happen the rest of that day and they will forget by Monday morning)
Nurse: “Hi Jessica, I spoke with edgepark rep this morning and discussed the insurance auth. I then called insurance IPA and this auth has to come from PCP, not endo, so I will fax the auth info to the PCP and they will submit it.”
Me: “Okay, but PCP doesn’t handle diabetes and didn’t even know she had diabetes when we saw him last. He probably doesn’t even know what a Dexcom is. Can you please call and talk to him or his nurse and explain and help them?”
Nurse: “Yes, I probably won’t be able to get through to him but I can tell his medical assistant. Once they submit it it should take about 3 days, or if he marks it as urgent it will be reviewed within 24 hours”
Me: “Thanks. I will try to contact them as well to make sure they know what is needed.” *hangs up*
So, we go through weekend… I am optimistic (I don’t know why) that things are looking up and finally maybe this will be over with.
Now, it’s Monday morning. I call PCP office, get put on hold forever. So I hang up and decide to call insurance to see if they received auth request. Of course not. Nothing. I explain the situation and how RX is from endo, but now must be submitted by PCP who has no idea about diabetes device as far as I know. Nice lady at insurance says “Well, the PCP should be receiving periodic updates from the specialist so he should at least know that she had diabetes. And he would have had to fill out the initial referral to the endocrinologist, so he should know she has diabetes” I try to explain that, yes, his office does probably receive periodic updates, but not like he reviews her chart on a regular basis if she isn’t there for an appointment. OR that he was on vacation when she was diagnosed so she was diagnosed, seen and referred to endo by a different dr at the same clinic (where there are like 15 drs). And, yes, she has seen him once since diagnosis and we got shocked and awed “Since when does she have diabetes?” when he sees Humalog on her current medications list. So, no, I don’t think he is going to have any clue about Dexcom or what and how to submit authorization all on his own without coaching from endo or patient’s caregiver (that would be me).
I thank nice insurance lady for her time and hang up. Call back PCP’s office because it seems, yet again, someone is falling down on the job. Get through pretty quickly and speak with receptionist. She pulls up Angelina’s file and sees notes from endo nurse on Friday. Says it looks like endo nurse was waiting for fax from Edgepark so she can send to PCP office, but after quick check with medical records, no fax received. She suggest I call back tomorrow because endo is at PCP office on Tuesdays and maybe they can get things figured out and get insurance auth request sent off. No better help for PCP to fill out Dexcom request than endo herself, right? Receptionist concur if endo is on the job, endo will get it taken care of. She is the very thorough and get things done type of doctor. However, they do not have fax. Hung up on must have fax, even after I try to explain that fax not needed from my understanding, only need to electronically submit codes. Suggest I call endo nurse today to find out what happen with fax?
So, I call the endo office and ask for endo nurse only to be informed she is not there today. What!?! Figures. Speak with different receptionist than other 12 times and explain that endo nurse was supposed to possibly, maybe have gotten fax on Friday and send to PCP office? Receptionist read endo nurse’s notes and says “From her notes it looks like we never got a fax.” I then try to use “Well, it’s just the codes that need to be forwarded to PCP and PCP needs to submit codes to insurance for auth. It was supposed to be on the cover sheet of the faxes endo nurse confirmed she received earlier in the week last week. No new fax needed, should be on prior faxes.” Receptionist insist they did not receive fax on Friday and must have fax. She can take a message for endo nurse to call back when she return tomorrow. No good for me. Then receptionist suggest I call edgepark and tell them to re-fax already faxed and confirmed received faxes from last week. No.
I call edgepark rep anyway, get voicemail. Leave manic, half-crazed sounding voicemail with long story about how everything all effed up. Can she please call me back ASAP? I will probably never hear from her again. So sad, no Dexcom yet.