When Allegheny Health Network & Highmark Aren’t on Speaking Terms

So I still have no date for my hysterectomy.

My doctor, Lee Hammons, joined Allegheny Women’s Health in September 2017. They are part of the Allegheny Health Network (AHN) which is owned by Highmark. We have Highmark insurance. But Highmark has not yet approved Dr. Hammons to perform surgeries. At least, that’s what his office is telling me. He’s approved for a handful of Highmark insurance programs, just not mine.

Being me, I called my insurance company’s dedicated unit for our plan. They looked up Dr. Hammons and said that, yes, in fact he is an approved in-network providers and has been since September 2017.

I called the scheduler at Allegheny Women’s Health and shared what I had learned. She checked her files and said it wasn’t showing up. She would check with the billing department and get back to me. I haven’t heard from her so I assume there’s nothing to report.

Meanwhile, I was waylaid by a really nasty virus. At first, it might be anemia. Then something was wrong with my white blood cell count. This was high, that was low. I learned that I cannot go to a UPMC Urgent Care any longer because it is out-of-network. And it turns out I have a really nasty virus which means I should postpone surgery plans until the New Year.

So I didn’t have the energy last week to try to get Highmark to talk with Allegheny Health Network about Dr. Hammons. I will try again this week because I’d like to get a surgery date. And I was told there are a dozen women ahead of me also waiting for surgical approval. It is unethical as hell that this is happening.

This isn’t elective surgery. This involves a dozen women who are in pain and suffering. It is ridiculous that we pay for this insurance, but they can’t proactively address a breakdown in communication with a doctor. It is equally ridiculous that the doctor’s office will be paid handily by the insurance and can’t take the time to call the dedicated unit for the plan to work out this snafu. And it is beyond the pale that they are THE SAME COMPANY.

And don’t get me started on UPMC Evilville kicking me out of Urgent Care because of the damn consent decree. This means I have to restart my search for a Primary Care Doctor which is certainly not on my list of things to do in the next few months.

Here’s what I believe to be true

  • This would not happen with Sports Medicine
  • The end of the Consent Decree in 2019 is going to be a genuine nightmare for Pittsburgh
  • Almost no one gets my reference to Dr. Robert ‘Rocket’ Romano these days which makes me feel very old
  • Allegheny Health Network is not effectively managing their companies. There’s no reason that Jim from Highmark Approval Department can’t call & fax over to Belinda from Doctor’s Billing Department when they realize the approval notice brokedown.
  • The flu shot is only 10% effective. The flu has not reached Allegheny County yet, so you don’t have it. But wash your hands and get that shot no matter what. 10% less vulnerability is still something.
  • If you are over 35 and have any sort of irregular period, don’t assume it is menopause. Don’t listen to your sister/mother/cousin/neighbor. Well, listen to them and go see your doctor. Get an informed opinion on whether you’ve started menopause (or perimenopause) and what that literally means for you. Buy your self a copy of Our Bodies, Ourselves: Menopause and read it. You deserve accurate information and good health.

Now I need a good night’s sleep because I expect to be on the phone a lot tomorrow trying to convince the Heat & Snow Misers to have a conversation. Sigh.

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