ljmydayaway (ljmydayaway) wrote in bad_service,

Bad service from doctors, or insurance?

I've been trying to get in to see a psychiatrist for over a month now. I've called nearly all of the psychiatrists on my plan (the only ones I haven't called either have incredibly bad reviews on Yelp or have office staff that I just can't understand at all... which... makes it really difficult for someone with extreme anxiety/panic disorders to try to talk to...).

Sorry in advance for htis being really disjointed, I am not in a good place mentally and can't find help. :/

The way my insurance works is not like any that I've ever seen. I have standard HMO insurance (with group # and everything) with United Healthcare, but my mental healthcare is covered by a third-party-ish United Behavioral Health/Optum (with no group # or HMO/PPO nonsense, from what they keep telling me).

I contacted a doctor, everything was groovy, I asked if they took my insurance and they said yes, then I said, "It's under UHC HMO, but it's also--"

Office Lackey: "We don't take HMO."

Me: "... uhm, like I was saying, the mental hea-"

Office Lackey: "We don't take HMO, sorry. You'll have to contact your insurance and find another doctor!"

Me: "My mental health insurance is through a third-"

Office Lackey: "We don't take HMO INSURANCE! We ONLY TAKE PPO insurance!"

Me: "-party and they said you're in-network, they verified it, you should be goo-"

Office Lackey: "We ONLY TAKE PPO"

He literally kept interrupting me just to parrot back that they don't take HMO insurance. OK, I UNDERSTAND that after the first time, however my insurance is weird and doesn't seem to work like normal insurance! I somehow managed to get out to him that I'd like to send over my insurance info so he can call the mental healthcare number on the back of the card and verify that they are in-network. He says he'll call me back "right away!" once he gets my card info. I manage to ask if he takes payments from Optum or United Behavioral Health, and if he bills the insurance directly, and he says yes to all.

Today, I email him again asking for an update. He immediately calls me (like maybe 5 minutes max after I sent the email) and says, "You have an HMO, we don't take HMO."

I asked him if he called my insurance company, and he said yes. I asked what number he called. He refused to read off a number, and just said "UHC." I asked what number again and who he spoke with, and he said, "UHC Mental Health Division."

There's been no such thing any time that I've ever called them. You have to call a seperate number and they usually call themselves United Behavioral Health or Optum or they just say liveandworkwell.com. At this point, I assume he's lying, but I tell him I'll call my insurance and hang up.

I email him back and request that his supervisor calls me immediately and tell him it's urgent.

I call my insurance after I've cooled down a bit, and they tell me that according to their phone records, no one from his office has called. Not only that, but they actually updated and verified their records less than a month ago. Meaning less than a month ago they were totally cool with getting paid by my insurance, but now they suddenly don't want to take my insurance because my main insurance is an HMO?

So I get home after work today, totally freaking out and crying in the car all the way home, and see an email from the doctor's office. I have my husband read it for me. The guy took a screencap from my health insurance's page, printed it, and circled where it says HMO. PROBLEM: The screencap is from UHC! My MAIN health insurance which IS an HMO! Not from liveandworkwell.com/United Behavioral Health/Optum. This pretty much just verified that he didn't bother to call the insurance company at all.

He also said in the email, "I will not be able to trouble the Dr. to explain to you again that we are not an HMO provider." More than anything, I want the Doctor to know what a jerk this guy has been to someone with anxiety/panic/depression disorder. At this point I really am not sure what to do, as I've called over 20 psychiatrists and there aren't any others that I can really access since no one ever has weekend/evening appointments and most of them are too far away (and I have zero paid sick time so I can't afford to leave work), and I live in a shitty city with shitty transportation. I just want medication so I can be fucking normal and not be curled up in a fetal position all day long. Why is it so difficult??

I can't tell if this guy is just being a turdwaffle because I'm on an HMO for my main insurance (which has nothing to do with my severe mental illness coverage as far as my insurance has been saying), or if my insurance is just lying to me repeatedly about them being in-network?

The only reason I'm gunning for this so hard is because they're the first office to actually call me back and have an opening. :/

TL;DR: Can't tell if insurance or doctor's office staff is being an asshole. Office staff won't say anything other than "We don't take HMO" and insurance says I should be covered. Cue me freaking out because I'm at my wits end with all of this.

EDIT: So... turns out it's a little of both insurance and the doctor being assholes. I finally managed to talk to someone who knows how the insurance works at the insurance company! My insurance IS processed like a regular HMO, just paid out from Optum/whatev at the same rate as a PPO would be. So if I had a PPO that had a slightly higher copay or a coinsurance, the doctor would get paid slightly more.

Basically, the doctor doesn't take HMO patients because he doesn't get that slightly more money out of them that he might get otherwise. (My husband's insurance is a PPO, and he'd only pay $10 more than I would, so... I don't really get it at all.) The doctor IS in network, just refuses to take HMO patients. :/ Insurance is such a stupid thing.

*I* feel like an even more socially awkward asshole than usual out of it because I was just telling the doctors what the people I had spoken to up to that point told ME.

I got assigned a care advocate by my insurance. He found me a doctor, and gave me the address.

The address is for a mental hospital. Not for the doctor's office. The doctor's office is in a different location. The address is just a hospital that the doctor works at. Not to mention that both the hospital and doctor have extremely terrible reviews (like "I was strapped to a chair overnight and force-injected with meds, after voluntarily admitting myself, and then not allowed to leave" bad for the hospital). ARGHH.
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