Thursday, May 01, 2008

Howard Stern On Steroids and Eye Docs.

Direct quote from a PWP Mom Blogger, "...Howard Stern on steroids..." in regards to Ms. Teacher thinking I am intimidating. Thanks, Yoli, that is a true compliment. I guess we get into that mode when there is a threat to our children!!

Anyway, we are busy at third thing (current employment). Just had two firings over ridiculous things (done by those fired). Finally though the SH is gone; though, a lawsuit remains. Next driving the company car without a license for a YEAR! Yea, he is gone too. Third Thing seems to be cleaning up the right people but also tending to leave those that should not be here too.

We have been busy and next week is teacher appreciation week at school. Finally my peonies bloomed so I hope they continue to bloom through Monday so I can take a flower to Ms. Teacher. They dictate to us what to bring each day. That is fine because it takes the worry out of it.

Also, in regards to the Eye Doc., G and I have independent insurance which is cheaper than group but also can exclude things by law which in turn makes it cheaper. So Tuesday I received a letter from the insurance company accusing me of misleading them in my original application, and, that if I didn't agree to allow a permanent exclusion on services related to G's eyes they would cancel our policy back to the effective date.

So, with the knot in the pit of my stomach and much trepidation, I called and said that I did not intentionally mislead anyone. I explained that G had a tear duct probe in Jan 2006 but that once it was done it was over and shouldn't be claimed as a recurring problem. What insurance companies are asking about usually are the things that could be recurring and therefore costly.

So come to find out, when I took G to a pediatric eye doc in Dec 2005 about what I thought was an irritation of the eyelashes (I thought her eye lid was turning in) it turned out to be a blocked tear duct causing lots of water drainage. The eye doc., though filed the claim with the tear duct and included a diagnosis of bilateral "some long word" which means extra muscles in both eyes causing the lids to turn in which irritates the cornea. Oh and that will require surgery if her diagnosis is correct.

She never told me that she was following that diagnosis nor did she tell me she was giving her that diagnosis. The insurance guy told me that I was right in that the tear duct would not have caused an issue since once it is done it is done, but the diagnosis with the long word is the problem and if G ever needs surgery on it I will have to pay out of pocket totally. Of course had I listed it they may or may not have excluded it anyway, but because they feel I mislead them, they most def will exclude it permanently now no matter what.

So I asked my mom (who was with me for the original appt.) if she remembered that diagnosis and she said, "No and you are right about not being told about it." I think if I were told G had extra muscles in her eyelid that caused them to turn in I would remember that even if said in the long word.

Needless to say I will be starting a collection for the potetial for future eyelid surgery on G' eyes. Just kidding, we don't anticipate any problems but getting any services paid from that provider may be a problem and a fight. Or I may just cut the anisthesia and tell her to buck up, heh. No seriously, I am truly kidding!! I didn't realize how much trouble these "Asian eyes" ** were.

** click the link before flaming to see what I am talking about.


Vivian M said...

Wow, how unethical for a doctor to not tell you her diagnosis, or worse yet, tell you one thing and list another for payment purposes.

Elizabeth said...

I can't believe that I didn't leave this snarky comment when you first posted about it... Seriously, I want to see the diagnosis code for "Asian Eyes." Is THAT considered a pre-existing condition?