The Special Circumstances Are That This Nurse Is A Jerk
Bad Behavior, Illinois, Medical Office, Nurses, USA | Healthy | January 20, 2021
My youngest has a form of club footing. We have been seeing a wonderful doctor, but he has moved states. We want to keep seeing him but need special permission from our insurance sent by her pediatrician. I call the office and talk to the head nurse.
Me: “My daughter’s orthopedist has moved states, but we want to keep seeing him. I talked to my insurance, and they claim that if my pediatrician sends in a ‘special circumstances’ form that they will waive the out-of-network fee. Can you please do that?”
Head Nurse: “Sure. We’ll send in for the special preauthorization today.” *Hangs up*
Ten days later, the preauthorization paperwork comes in the mail, and I instantly see a problem. I call the insurance company to see if it was an oversight on their end.
Representative: “Thank you for calling [Insurance Company]; I’m [Representative]. How may I assist you today?”
Me: “I just got my preauthorization to continue seeing my orthopedist of choice, but there’s an issue. It says his previous place of employment, and he moved states. I was just checking to see if it was an oversight.”
Representative: “Oh, I see. Can you please verify your identification so I can proceed?”
Me: “Certainly.”
I complete the three-step verification.
Representative: “I see what happened. Your pediatrician’s office didn’t fill out the proper paperwork. I’ll send it over to them so it can be corrected. Is there anything else I can assist with?”
Me: “Only for you to have a fantastic day. You have assisted me wonderfully, thank you.” *Hangs up*
Five days later, the head nurse calls me and immediately has an attitude that I would classify as an annoyed parent talking to a toddler.
Head Nurse: “[My Name]? This is [Head Nurse]. We received some paperwork to fill out from your insurance stating that you want special circumstance paperwork filled out to keep seeing your orthopedist. Care to explain that to me?”
Me: “Yes. As I said two weeks ago, our preferred orthopedist moved from his previous office to another one in a different state. He did a great job with her first surgery, and we want to keep him for her subsequent surgeries. The only way that can happen is if you guys fill out the paperwork that was sent to you.”
Head Nurse: “You most certainly did not tell me anything like that two weeks ago. There are perfectly okay doctors that can handle her ‘issues’.”
When she says, “issues,” she changes her tone to sound more sarcastic.
Me: “I understand that they’re okay, but if I move to another orthopedist, then we have to again have a preliminary visit and brace trial and error before her next surgery, which could take months again. If you fill that paperwork out, I can get her the much-needed surgery within the month. Her orthopedist is just sitting on go for the paperwork to be sent in. Please, can you have the doctor fill out the paperwork so she isn’t forced to wait unnecessarily for the surgery that will let her finally walk after years of her crawling only?!”
Head Nurse: “I will not send this paperwork for the doctor to fill out. The preauthorization you already have will work just fine for a doctor at the office you’ve been accepted to. You don’t need to see him just because you feel like it.”
Me: “I am not going to accept a ‘just okay’ doctor when my current orthopedist knows her issues well and is ready to do the surgery. If you don’t understand why it frustrates me that you won’t have the doctor sign the paperwork, and you’re forcing her months longer of just crawling, then I’ll make an appointment to see the pediatrician to have her fill the form out.”
Head Nurse: “I’m sorry that you don’t understand me. I will have the form shredded before the appointment and a call in to the insurance company that you changed your mind. With my call, you will be ineligible for another ‘special circumstances’ form for twelve months. Goodbye.”
Yes, she did put in to the insurance that I didn’t want the original orthopedist, so it’d be 100% out of pocket, upwards of $500,000, and I couldn’t get another form for twelve months. I reported her for her unprofessionalism, but nothing seems to have come from it; she was there when I brought my other child to her check-up. Joke’s on her, though; I got accepted at the leading non-profit hospital and don’t have to go through that office for pre-authorization again. I also don’t have to go through the rigorous multiple appointments and brace attempts before surgery.
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