(Names changes as requested)
Many years ago, I worked for a school division as a Special Education Resource Teacher. I was school based, which meant I was stationed at and worked at only one particular school. Because of the nature of the job, I did not have a registered class, which meant that when I was ill, I did not require a substitute. I was required, however, to call in to the automated line along with everyone else to register my absence.
Once, when I was ill and called in sick, I spent almost an hour trying to get through to the automated line because I was competing with every other sick teacher in the school division during flu season, most of whom required a substitute. We were required to cancel our subs by using the same automated line when we returned to work.
Upon returning to work, I received a call from the substitute clerk. She berated me for not having canceled my substitute. When I explained to her that I did not have a substitute, she yelled that I was required to cancel the substitute anyway. I said, ‘You’re telling me that I have to cancel the substitute I didn’t have?’
‘Yes!’ she replied. ‘You must cancel the substitute you didn’t have or we will not pay you for the time you were absent.’
Now that I am a well spouse, I am no longer surprised at the craziness that goes on when trying to work your way through the medical and insurance systems. We are bombarded with forms, often presented with contradictory requirements, impractical responses to questions that usually make no sense, or instructions that cannot be followed. It is comforting and frustrating at the same time to know you’re not alone in this situation. Let me share some other well spouses’ experiences that will show you just how common this experience is.
Marcia’s husband needed to be transported from a hospital in one province of Canada to another. He was required to have a nurse with him during the transfer. The date of the transfer was unknown because it was subject to a bed becoming available at the other facility. There would be no warning of an available bed, just a call that one was now free and a requirement that Marcia’s husband fly to the other province in order to occupy the bed within 48 hours or lose the space. This meant a last minute airline ticket – if one was available, and a nurse who could free herself for two days at the last minute.
Many nurses volunteered for the job providing that their schedule would allow it and that holidays were not near. No one would commit for an unknown date. Marcia’s insurance company would cover the cost of the nursing care, but pre-approval was required. Marcia received the forms from the insurance company and had the doctor fill them out and fax them in as required. The insurance company would not pre-authorize unless they knew who the nurse was, his credentials, and what he would charge.
Yes, they understood that Marcia could not provide this information until the time when a bed was available. Yes, they understood that he had to be there within 48 hours. Yes, it would take up to a week to get pre-authorization once they had the information. And, yes the cost of the nurse would not be paid without preauthorization.
Barnet found himself in a similar situation. He too needed preauthorization for a nurse and had very little time in which to get it. He faxed his forms in and waited three days for a response before calling. Many messages on an answering machine later, he received a response saying the fax had never arrived. Resubmitting, he was told that the forms had indeed arrived the first time, but had been sent ‘out of country’ and he should contact a Corinne at a new phone number. When Barnet called the new number, they knew nothing about the papers and had no idea who Corinne was. Meanwhile, time was running out.
Darren also had a similar problem when trying to deal with his insurance company on a matter that needed pre- approval for payment and was required immediately. But when he reached a dead end after days of plodding through automated menus, answering machine messages that went unanswered and referrals to people that were never heard of, he called back his original contact. He explained how frustrated he was and how time was so important. Tracy, the woman at the other end took it upon herself to contact the appropriate people, walk the papers through and get back to him with the pre approval within the day.
The only advice I can offer when dealing with the system and the people who run it is to keep your sense of humor. These stories, as awful as they are when experienced, really make for a good story to be shared at a later date.
My encounter with the clerk who adamantly told me that I had to cancel the substitute I didn’t have never fails to bring a smile to my face when I think about it.
Also, when you find a ‘Tracy’ – someone who goes out of her way to help – make sure you thank her appropriately so that she can continue to be willing to help others in a situation where doing so is, indeed, going above and beyond.
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