Step 1 … this is getting laughable

So first it was the HMO that gave us issues.  Then is was the Healthcare provider.  Now we are back at the HMO, where in the words of my wife: “They’re running their operations on sticky notes purchased from the dollar store.”

We finally got Aetna, to provide us a list of ABA therapists in the area that we can work with under my healthcare plan.  Went through the list, and found a provider that we like.  Last step is for them to get the authorization by our healthcare group to do it.  They get denied on the basis that we needed a referral.  We go to Chase’s pediatrician, to help straighten it out, and get us the referral.  When she goes and tries to process it through the HMO, she gets denied, with a response to call a 1-800 number.  Two days later we get a letter from Hills Physicians (our HMO) stating that we can’t work with the provider we selected, and that we should work with ******** (name redacted) and listed the same 1-800 number.

Problem is that 1-800 number is no longer in service.

Are you fucking kidding me!?! So I call up Hills Physicians, and instruct them the number is out of service.  The girl on the other end, double checks and sure enough, that number is out of service.  Ok so we agree on one thing, they are telling me (and all others with kids that have Autism) to go somewhere that doesn’t exist.  Next the headset phone jockey, conferences in Aetna to understand what’s going on, and this is where it gets laughable.

The girl from Aetna, tells the girl from Hills, that Aetna changed their policy months ago, Hills was notified back then, and they need to update their records once and fo all.  And that was just the start.  If I get snarky with Hills, they hang up the phone without as much as a warning,but they can’t do that to Aetna, because after all Aetna pays their bills.  The girl from Aetna, made enough remarks to Hills in the perfect passive agressive stance, I had to mute myself from laughing.

This reminded me of the time, that I had a doctor fax paperwork to Hills, and it took over a week for them to get the fax.  Healthcare notes, and charts are still faxed back and forth.  Faxing is huge in this industry, so you would think Hills would have something more sophisticated than a hamster running on a wheel to manage their fax systems.  I work for a 550 person company.  If you fax me something, within minutes I get an email with the fax as a PDF attachment.  My company creates enterprise software, that amongst other things, has a product that can analyze a PDF (or any faxed image) and extract content from it. We are not alone in this industry, there are literally hundreds (maybe thousands) of solutions that do this to varying degrees and costs.

In the end, we were told by the Aetna girl to stop dealing with Hills for any ABA, or other behavioral therapy needs, as they can’t seem to figure their left hand out from their right hand (and yes the headset phone jockey from Hills was on the phone and listening to this).  We were given a direct line into Aetna, and instructions that we should share with any providers we work with.  Oh and the provider we were trying to use, was already approved in Aetna’s systems.  For some reason Hills didn’t want to release this approval, which incited even more snarky remarks from the girl at Aetna.

We hope to be starting ABA therapy in the next couple of weeks, and are happy to report that Aetna is really starting to help us out.  We have a case worker from Aetna, whom is very helpful, and will even work with me to navigate the system, and get the max benefit for my family, at the cost of her company.

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