Claim Denied

For those wondering how my surgery went?  Well, it didn't.  I received a call on evening of May 5, 10 hours and 40 minutes before my scheduled surgery telling me my insurance denied my claim.  The excuse given was that my insurance company had recently changed their criteria.  Now I do know, for a fact, that insurance companies do change criteria, sometimes quite often.  What has me more then a little concerned was that I agreed to the surgery back on April 2.  What I'm hearing from a lot of people is it should not have taken 33 days and some 13 odd hours for my surgical team to find out about this denial.  There is a last ditch effort in which there was a Peer to Peer doctor review to get a quick approval on an appeal.

So here I sit waiting while my FMLA slowly runs out.

Oh, and they know I'm not very happy.

And I keep think back to Tiara, and how she had such a difficult time getting my FMLA (leave of absence) form processed correctly.  Why?  Because on one of the times that I called I was told that she was in charge of forms.  Would someone whose responsibility it was to fill out all forms be the one person to file an insurance claim?  I'm thinking it probably is.  Which leads me to believe that she did just a shitty job filling out my insurance claim.

The Tarnished Tiara

I was contacted by corporate yesterday regarding my Leave of Absence.  First of all, it isn't a full LOA, it's actually FMLA - you know the Family Medical Leave Act.  What that does is guarantee that my position and rate of pay will be guaranteed for 12 weeks.  I can go on full Leave of Absence for 12 months, but after the first 3 months my position and rate of pay are no longer guaranteed.  The HR rep I spoke to said store usually don't demote you.  Anyway, this is important because Tiara, the associate at Arlington Orthopedic Specialists totally ignored everything I said when I gave her my paperwork.  I had told her my LOA needed to begin on 3/30 and run until 6/20 which was not what was written on the form.

She listed my starting date as 5/6 (the date of my surgery) and running until 7/29 and then beginning again on 7/30 and running until 11/6.  So I called Arlington and the first person I talked to was  really surprised by the November date.  And, of course, I had to wait on the line for almost 15 minutes before Tiara finally picked up her extension.  When I explained the situation to her she said "but that's your surgery date and we automatically extend it for 6 months."  So, I explained the situation again repeating how my surgeon said it was "realistic" for me to go back to work on 6/20 with restrictions.  And Tiara said, "well, you can go back to work any time."  And I wondered if someone had hit her with a stupid brick, or was she normally this inept.

Anyway, she agreed to changed the dates on the form and fax it a 2nd time back to corporate.  I will call corporate later this morning to make sure Tiara did the right thing.  I've already talked to the store and they know when I return I'll have restrictions.  I wasn't that impressed with Tiara to begin with, but now I know she truly is tarnished.

Tiara - What's in a name?

In order to be officially put on LOA I needed to have my Orthopedic Specialist complete paperwork and have it faxed to the home office in Atlanta.  I was surprised when I was told there would be a $10 charge for this service, and even more surprised when I was told it would take 7 - 10 days.  Today was the 8th day so I called the office to find out if the paperwork was completed.  I got to speak to Tiara whose job, it seems, is to ensure all forms are filled out and faxed correctly.  I was told my form will be faxed today.  And after I got off the phone I wondered to myself why anyone would name their child Tiara.  This is what I picture when I think of Tiara.

Now I will have to tell you that I've met Tiara.  This is not what she looks like, not sparkly or shiny at all.  In fact she is too large to be called full-figured.  She does not have a glittery personality.  For her everything seems to be an almost insurmountable task.  She responds to questions slowly, as though pronouncing each syllable in an unprecedented chore.  And, unless she changes it, she will go through life with this name.

Occasionally you will hear of celebrities giving their children odd names, but then they are a quirky bunch.  It's more then a bit different when the average person gives their child an unusual name.  About 10 years ago, when I was still working for IP, the 16 year old sister of one of the young women working in my office gave birth to a baby girl and named her Ariel.  All we could do was look at each other and mutter, "holy shit, she named her after the Little Mermaid."  Now there really is nothing wrong with naming your child Tiara or Ariel, just remember that not everybody is going to like that name as much as you do, in fact, if the child grows up to not be a Tiara or an Ariel, that name my just bite them in the ass.