School insurance delays my visit to a sleep doctor because..

[benz42428]

I was a little reluctant about posting this because I wasn't sure how many people could offer an advice regarding a college insurance. But hey, last time I asked something along this line here I got a really good advice, so might as well try
Some of you might have known but I am a graduate student. I'll be more specific: I am actually a student in one of the University of California campuses. I am using the college insurance right now. I have no complaints about the benefits, but there have been so many "technical problems" that I start to doubt that this insurance is actually for the good of the students. So first, for this insurance, you have to see a doctor in the university health center in order to get ANY referrals. Sounds easy, but to see a doctor, usually I have to wait for about a month after making the appointment (I guess that's a bonus for being in a super-big university). That is the first delay for my consultation for the sleep doctor
I got to see the doctor on August 12th, exactly a month after I made the appointment. The doctor agreed to write a referral, but it needed to be approved by the insurance office (in the health center). Now, here's the problem, the insurance for the spring semester ended on August 14th, and any visit described in a referral must be done by that date. Making the matter more complicated is that the insurance company in Spring was Anthem, but in fall, it is switched to Aetna. I sensed there would be a problem there, so I asked the doctor to specifically make sure that his referral would be authorized on August 15th. He sent a memo to the insurance office regarding that, and all seems to be good.
However, the insurance office authorized for my visit to sleep doctor on August 13th, and expected me to make an appointment and see the doctor before August 15th! So I went to the insurance office and told them to renew my referral. The guy there wasn't sure if that could be done without seeing the doctor again, but for one thing, he cannot even try because Aetna "hasn't finished enrolling students to the insurance program." I do not have any insurance ID number so he cannot even start on working on renewing the referral. He told me that Aetna's enrollment is not going to be finished for the next 3 weeks, so I have to wait until them. I told him that this is a breach of agreement, given that the insurance manual clearly states that full benefits begin on August 15th and it is inappropriate that I'll be restricted to partial benefits for 3 weeks for something that is totally not my fault (I can still see doctors in the health center or ER but neither is the place for sleep apnea...). He said there is nothing he could do.
Now, three weeks might not be a long time in some people's opinions, but in theory my visit to the doctor could be delayed longer than that. For one, the insurance guy isn't even sure if I have to see the doctor again for the new referral (this takes a month), and even if I got a referral the sleep clinic might not be able to put me in until 1-2 months later (the sleep clinic will not let me make an appt without a referral). And what guarantees that Aetna will finish enrolling students in 3 weeks? If I am unlucky, I probably have to wait for almost 3 months to be seen. And I really need a consultation because my apnea is getting bad and I probably need a better CPAP mask. I really want to fight for my rights, but currently I am not sure what would be the best way to go (I don't think I can just go to the insurance office again and force them to acknowledge my entitlement to full benefits). I am not a US citizen and has not been here for that long, so I don't really know what options I have here. I know that my issue here might be somewhat specific and maybe not people do have a similar experience. But I'd really appreciate any advice I could get here. I thank you all in advance.

PS. I am not sure why this doesn't show up on my profile but my machine is Resmed S8 elite II, pressure = 10 cm H2O. Just in case some of you want to know

[kaiasgram]

benz, is it GSHIP insurance?

[benz42428]

benz, is it GSHIP insurance?

Yes, if you meant a SHIP for graduate student

[kaiasgram]

Yes. I don't know which UC campus you're on, so I went to the UC Davis website which refers to using "Aetna Student Health" starting in the Fall. Here's the Aetna Student Health website where you can look up your school: https://www.aetnastudenthealth.com/

Can you contact the doctor you saw who did the first referral and ask him to submit a new referral now instead of trying to get the Student Health office to renew the current referral? I know there will still be a holdup with the Aetna enrollment process, but I wondered if you could find out what sleep doctor and sleep center you would be going to under the new Aetna plan (using the website link above), and see if you can get an appointment date set up. Even if your new insurance plan hasn't authorized the actual visit(s) yet, I just wonder if you can get an appointment on the books with the idea that the new authorization will have gone through by the time your appointment date arrives.

I know this would require some research and phone calls and leg-work on your part, and I know you're feeling really crummy and tired right now. I'm just trying to brainstorm what I might do in your situation, and think I'd try to look for some kind of workaround because of the current holdup. Going to the SHIP office to argue that you're entitled to not have services interrupted probably won't get you what you need. But trying to find a way to keep things moving despite the temporary standstill in insurance enrollment might have a better chance of working.

Maybe you could even call Aetna Student Health and ask them to fast-track your enrollment because of a pending referral.

Keep us posted.

[islandboy5150]

So, you're figuring out now how insurance companies give people that run-around eh? Let me tell you, the insurance problems your facing aren't limited to where you are. They all operate that way. They make it as difficult as possible for you to obtain services, so they don't have to pay for them. Any delay, "technical disruption", clerical error, understaffing customer service, any and every time consuming rule or burden they can think of is only to delay your treatment and save them money. They all do it in some fashion. Still, it's better than government beurocracy administering your health care.

[chunkyfrog]

Sometimes the only way we can fight the "gatekeepers" is to document every dirty thing they do,
and make sure the most people possible know about it. Perhaps a visit to university administration
would make sense--it is a medical matter. Journalists are slathering for the chance for a career-defining exposé!