Molina and the Mayo Clinic are driving me insane

[wafloodzone]

At the end of July I 2011 was in a motorcycle accident that ended with an avulsion of the Brachial Plexus C5 – C8 and T1 of my left. After research and surgical suggestions from all of you I self referred myself to the Mayo Clinic, scheduled a consultation for the middle of Dec. and gave them all my information including my insurance. The week before I was scheduled to go I made 1 final call to Mayo Clinic to make sure everything was in order. They looked it over and found that my insurance (Molina) had not approved the consultation. The trip was cancelled and the fight with Molina began. After many letters and phone calls from me and my family Dr to Molina they finally agreed the consultation and would approve the surgery based in the outcome. When I arrived at Mayo Clinic they sent me to the business office who informed me that they do not have a contract to bill Molina in Washington State and that I would have to pre-pay $7,000.00 and bill Molina directly for a reimbursement. My mom (best mom ever) agreed to pre-pay. The team at Mayo Clinic deemed that surgery was needed and set a surgery date for Mar 4th. The appointment desk referred me back to the business office. They told me that I would need to pre-pay $150,000.00 (like we have that kind of money laying around). I contacted Molina to get surgery approved. I also informed them Mayo Clinic wanted the $150K cash deposit. Molina told me that per medicade/medicare rules No monies were to be paid by me and if we pre-paid we most likely won’t be refunded. Why they didn’t tell us before the consultation I’ll never know. So now we have 2 weeks to get Molina and Mayo Clinic to agree. I was thrilled when I got a letter from Molina approving the surgery. Airline tickets paid, hotels paid, shuttle service paid, I’m ready to go. 4 days before departure I called Molina to make a final check and that everyone was doing their job. I was transferred around a few times before I got an agent that said payment had not been approved. I told them that I have a letter saying surgery is approved. Apparently just because you have approval for surgery doesn’t payment was approved. 2 separate approvals. WHAT! 4 days before I leave and this hadn’t been taken care of. 3 days before departure: frantic phone calls from me to Mayo Clinic, Molina and my family DR that resulted in a conference the next morning @ 8:30am. 2 days before departure: Friday conference call, meetings behind closed doors. Result: Molina and the Mayo have not reached an agreement so 3:00pm Friday surgery was officially canceled…again. I was told by the surgeon’s secretary that this was not a time sensitive operation and that they would work together to try to get this resolved. It might take a couple week maybe months. Well, this might not be time sensitive operation for them but IT SURE AS HELL IS FOR ME. So now it’s Friday afternoon and instead of packing I’m cancelling plane tickets, hotels, shuttles. Sorry for the rambling and trust there is a lot of other crap that went on during this time. I could be writing for days.

So in the end as I sit here on the sofa feeling sorry for myself I cry for all the loses in these past months: The use and feeling of my left arm, my motorcycle, my part time job that I had been at for 10 years, my second part time job that I’d been at for 3 years (now I have no income. unemployment and social security denied me. Both are in appeals). I also broke my car (bad reaction to one of my meds, I tried to drive it into my office-new meds now). In 8 months I’ve gone from being a successful single mom to welfare standing in line at the food bank.

I know that everyone here has a story to tell and I’m not alone in this fight which is why I post my story here. You are the only ones that understand not only the physical but the inner turmoil we endure. Pity party will be over tomorrow as I have a 3rd attempt at surgery to prepare for. I’m not blaming Mayo Clinic or Molina, rules are rules. I am however blaming, after repeated calls from me, both of them dropped the ball and didn’t do their jobs. It's just that simple. It's what they are paid to do.

[jmar]

the surgeons secretary told you it is not time sensitive? did she get her info from the dr? this IS a time sensitive surgery! i know that personally. i was 14 months out when i had my surgery. that was almost too late. my muscle was already turning to fat. if i would have waited any longer, i would not have any function at all right now because the surgery would have done no good. call another BPI SPECIALIST that will not let this happen. if i were you, i would spend monday calling, e-mailing, contacting any BPI specialist you can. it has been 8 months? you gotta get it going. soon.

[Christopher]

Wafloodzone,

So sorry to read about this BS. Yes, it is ridiculously typical. I have been through the ringer with insurance and it took years to solve. My credit is still reeling from surgeries 7 years ago.

Insurance companies will do what ever they can to NOT pay if there is a way out, or any grey zone in what the claim is. They rarely have any regard for the timeliness and importance of the individuals situation.

The only way I could get my insurance to pay the medical bills (which I always paid them, my insurance, to cover if a medical situation ever arose) was to go into an office physically and show someone my atrophied arm that was a fraction of the size of my healthy uninjured arm. And by twisted luck, the insurance agent I spoke with had lost her brother the year previous in a motorcycle accident, and that may be the only reason why I got them to pay at all.

Persistence is the key. Call them as often as needed and use your wisdom and try and reach someone's heart. I couldn't have done it with out help probably. I would've given up a lot sooner out of pride & frustration.

If the Mayo said that the surgery is NOT time sensitive, then they must be only considering a muscle transfer as an option and not attempting to re-innervate existing (and atrophying) muscles in your arm/hand/shoulder with a nerve transfer. If this is the case it could be for several different reasons, such as there aren't any aceptable nerves available for transfer to an existing muscle.

I wish you the best of luck, and know that there are people who do understand the turmoil and anguish that this injury can bring with it.

Wishing you the Best,

Christopher

[jmar]

chris, you may be right about the time sensitivity issue. my concern is that she got that info from the secretary. i just hope the secretary gave her the right information. i would want to hear that from the nurse at least, if not from the dr himself. i know all too well about that wait game.

[suzannesteam]

Wafloodzone,
My son has same injury C5-T1, right arm. He was 17 at time of TBPI from football. I completely understand the insurance headache. I called every week prior to both of my son’s surgeries to make sure it was still approved and documented it and was given a reference number for each and every call and who I spoke to. I want to make a recommendation to you about the insurance. You may want to contact your state’s Insurance Commissioner. They may be able to help you with your insurance company with making the necessary payment commitment that the Mayo wants up front. If that fails, I too do not recommend you wait and find another doctor. The Dr. Susan MacKinnon I read about here at the UBPN is excellent. I also have the link here for the Washington State Insurance Commission:
http://www.insurance.wa.gov/consumers/h ... rage.shtml
Good luck with everything. My sincerest thoughts and prayers are with you.

[jmar]

dr mackinnon is wonderful. she did my surgery and done wonders with my hand function.

[wafloodzone]

Thank you all for your support and suggestions. It's comforting to know that I'm not alone in this fight. My new goal is to have this insurance issue resolved and have a date set for surgery, wherever that may be, by the end of this month.

Lisa.

[jmar]

good luck, lisa.

[Master DIVER TOM]

I really was happy to see the advice by posting here and the support given on this sight There is a real emotional Harm in the lack of direction We find ourselves in dealing with the injuries latter in life or at birth. The lack of help and direction or how to deal with the situation , Will leave you in despair till you can find a direction to move forwards. Determination to over come or a disposition of never giving up is real for US, so is the compassion we have here. Sometime we do get overwhelmed by the situation of lack of direction for sure. But we forget the value of how far we have come by trying. A moment of Peace is a great to, by remembering what you have done in-spite of limitation of injury or the Lack of finding direction.
Good luck,Lisa
Tom

[billvxii]

Hi Lisa,
I'm just getting started with the same idiocy. My ins co is different but knowing the first visit to Mayo is testing and consultation they approved only consultation so we are in a struggle with that.Luckily I found out better than six weeks early.
My accident was Sept 15 last year so I am feeling the strain of time also. All my breakage visible on the side of this post.
Hope it gets better for you soon.
Don't forget to use that crying on the agents too, it works.
Bill