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  • KT

Delays and Obstruction of Care

I was having some gastrointestinal issues and it took six months to get an appointment with a GI specialist. He recommended an EGD or scope of my esophagus and stomach to help diagnosis my acid reflux. The procedure was scheduled for two months out. Three days prior to my procedure, I received a call from pre-registration confirming my information. The next day, they called me and said the insurance company hadn't yet approved the procedure and I would have to cancel. After waiting two months to have this test, I didn't want to put it off, or risk delaying it till the first of the year and having to pay another deductible. More importantly, the delay could be harmful to my health, if something serious was going on.

I contacted my insurance company and learned that the doctor's office had just sent the pre-authorization request that day - two days prior to the procedure! After spending two hours on the phone and talking to six people, I finally got someone with the insurance company to send a note to expedite the request. I contacted the doctor's office three times the day before the procedure to see if they had received approval and never heard back. I contacted my insurance company again and was finally told my procedure was approved. I never heard back from the doctor's office. If I had not taken steps to secure insurance coverage for the procedure, I would have been responsible for the cost or would have had to postpone the test. The hurdles imposed by the pre-authorization process required by my insurance company were aggravating, time-consuming, and potentially dangerous to my health.

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