Archive for the 'Health Insurance Makes Me Crazy' category

Things That Keep Me From Blogging

Disorganization. Procrastination. Endless estate paperwork and ensuing depression.

Trips back to western PA to empty out the house, and ensuing depression. Knowing the house is finally empty, putting it on the market, selling it two days later, and ensuing depression.

Sunday evening making a cake while dreaming about renovating my ugly kitchen when suddenly the power goes out because the electric panel died, 24 hours before a planned trip so hello emergency electrician, goodbye 10% reno budget...and cue ensuing depression. While a supposed-to-be vacation week is suddenly and terrifyingly made a visit-to-the-hospital week, returning home with worry worry worry on the mind, and ensuing depression.

A garden that was the source of pleasure and rejuvenation now overrun with weeds, baked dry as a bone, plants dying or suffering powdery mildew - in just one week! - looking like an eyesore and a hopeless chore, and ensuing depression.

Some hours on the phone for a $$$ doctor's bill the insurance won't pay, for the same test they paid for a month prior, submitted with an incorrect procedure code, impossible! for the aggressive billing office to deal with in any way, and ensuing depression.

No thing is unbearable, but everything is. No thing is impossible to deal with, but everything is difficult and draining and filled with despair.

No thing keeps me from blogging, but everything does.

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Just Another Week in the Health Care Trenches

Some things I did this week:

1. Wrote a check for $5 for a copay; probably cost the doctor's practice more in time, paper & postage to send me the bill.

2. Wrote a check for $thousands to a nursing facility. Thought about how many people can't afford this care (including me when I am older).

3. Called about a bill  for ~$25 that showed Medicare billed, but "Secondary Insurance: None" to let them know Z-mom has secondary insurance and they should re-submit bill. Told to fill out back of bill with secondary insurance information and send it back. Tried not to think about cost of time to resolve this.

4. Called the pharmacy required by nursing facility to ask them if they had made progress in getting approval from Z-mom's insurance. Found out the person working this issue had left the company.

5. Filled in new person at pharmacy on backstory, got them working the problem.

6. Called Mr. Person at company that owned the mine my dad worked for, to talk about Z-mom's prescription coverage and ask about the pharmacy in #4. Granted a six-month "trial" exemption to use the pharmacy, but have to send written request.

8. Got approval to submit for reimbursement already paid bills for $hundreds of meds. Wondered what people do who can't pay out of pocket in advance. Or at all.

9. Sent email and wrote follow-up signed written request.

10. Tried not to think about six months from now.

Oh, United States of America! You do indeed have The Best Health Insurance in the World!

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All Good Things...Eldercare Version

You’ve been traveling on the Enterprise E(ldercare), when one day you burst into your therapist’s office confused, upset, wanting to know what’s going on, what the hell you are supposed to be doing, and why she was on the holodeck with Worf. You feel at a loss, half-recalled pieces of the past and visions of your future mixing with your present. In short, you have become unstuck in time.

You were perfectly fine with your role in Engineering; serving drinks in Ten Forward; trying to corral tweens Jean-Luc, Ro Laren, and Guinan; or just being a red shirt. But now the Enterprise E(ldercare) has been ordered to investigate an anomaly in the Nursing Home System of the Senior Living Zone. Off you go. And there it is, a large anomaly threatening to consume you, your ship, and your elder. You go in for a closer look and…

Suddenly, you are back in your youth. The anomaly is bigger, but you are stronger, more confident, maybe even a bit arrogant. You take the Enterprise D(evilmaycare) out against explicit orders to see what's going on. You drive it around late at night, with too many of your friends in it, hepped up on synthahol. You ignore the jeering fools on the sidelines as best you can. You set off for Far Point University with barely a "make it so". On the way you run right over the trappings of your childhood once carefully hoarded by your elder.

Wait! That was a dream! Wasn't it? But it felt real. Who was that callous ass who paid so little regard to the feelings and concerns of others? And why was that anomaly so damn big?

Whoa! You’ve been put out to pasture; your joints are creaky, your hair is white, and you've got early onset Irumodic Syndrome. But you remember, you remember, you remember...there was an...an anomaly...your family is visiting, you desperately need to communicate to them the importance of going back there, because you were just there, it is real, it is not a dream, it is happening now. And they speak soothingly, and promise to take you there, and...

No, you are back in the present! That's just a vision of the future, some projected bad acid trip. You do remember the past. If only people would listen to you when you tell them it's bigger in the past...

And you're back there, and you are taking Enterprise D(evilmaycare) further and further out ...

Into the future, where your kids and ex-wife remind you that you that Irumodic Syndrome is causing your brain to deteriorate, and this is all in your head.  But they promise to take you for a ride anyway, and that goddamn son of your is driving the Enterprise E(ldercare) and after a spin around the block he insists it’s time to go home and you say "no, no, we have to go to the Devron System!" and you become increasingly agitated and they say we were already there and we're on our way back and here's some haldol and wait those aren't your kids and those aren’t Starfleet uniforms and a voice whispers to you that the only way to understand the anomaly is with a letter-call-visit (LCV) beam...

You are talking to the staff of the nursing home where your elder is now staying. You suggest a more aggressive LCV beam to deal with the health care bureaucracy and to fight depression in your elder, making physical therapy more effective. Your family needs professional support in this, and some sort of data organizer. And you think...

That you should use a LCV beam all the way out here at Far Point University And Beyond. Yes! Make it so!

And waking from the haldol you insist you do remember the Devron System, you must go there, the LCV beam is absolutely critical, and they wheel you to the holodeck and set up the Wii bowling...

And now in the present you realize that the LCV beams from all three time periods are together creating the anomaly, which is indeed a temporal anomaly. But the LCV beams must not be disengaged, they must be made stronger in each time period. (Your therapist tells you to ignore that little voice which says you are going to be responsible for the destruction of humanity, that’s just internalized homophobia.)  Together the LCV beams create a static warpshell and blammo!

You find yourself in the present, wishing that when you’d gone to Far Point University And Beyond you could have somehow brought the Enterprise D(evilmaycare) back to the spacestation a bit more often. The little voice in the future, the one that whispered about the LCV beam, was also going to tell you how to arrange things so that people can do useful work and keep their elders close by, and not have to worry about their own elder care years, but it stopped short. All you can do is share your time-travel story, finally join the poker game – and keep that LCV beam going.

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A Week Went By And Now It's July...er...August

Ain't this boogie a mess!

It sure has been, for two months.  I had that triumphant return to the blog at the end of May - had finally broken that evil six month headache, was feeling great, life was good! About a week later things came crashing down around me.  I don't feel like I can go into a lot of details right now, but there was a death in my family, Z-mom went into the hospital right after the funeral, and a member of Mr. Z's family went into the hospital on the same day.  Mr. Z's family member is doing well now.  Z-mom has had a horrible medical odyssey, from hospital to a rehab place that, in my opinion, almost killed her through a combination of neglect, misunderstanding, and direct incompetence. Thus back to the hospital to be saved, then to a second rehab place where she did not thrive through a combination of grief and not liking the facility.  We finally moved her to a third facility where she is much happier, the quality of care is extremely high, and the results in just one week are amazing.  We are daring to be hopeful and happy now.

It was fortunate for me that I had just come off the week of hospitalization for migraine, and thus was as well positioned as I could hope to be to go through these last two months of intense emotional and physical stress.  So yay for that.  But the entire experience with Z-mom has only more strongly reinforced some things I already knew.

When an elderly person is in the hospital, you cannot just assume that they are being taken care of and all their needs are being met.  The nursing staff is often excellent and gives excellent care; they see more than the doctors and can tell you a lot about how your family member is doing - how they fared during the night, if there's been a change in some functioning.  But you still need to be there a lot to see what is going on - how well they are able to feed themselves, how well they are able to work with PT and what the key issues are, just in general what their mood is like, what needs they have that you could meet.  Most importantly, you need to be there early in the morning when the doctors are doing rounds, so you can speak with the doctor yourself, even if it is just for a few minutes.  This is when you can ask questions and get information about what therapies are being prescribed, or should be prescribed.  You can ask, why is my family member doing x or y, looking like this or that, acting this way?  If you aren't satisfied with the answer, push for more.  Ask them to slow down so you can write things down, and to explain words or concepts you don't understand.  If your loved one is about to be transferred to another facility, you will usually have some interaction with a social worker. They are good sources of information and are there to help you so don't feel bad about asking questions.

If your loved one is transferred to a rehab hospital, again you can't afford to take your eye off things.  You can't, of course, be there every minute they are doing therapy, nor should you, but you can sit in on some therapy sessions and interact with them and the therapist to aid in the therapy and learn what you might need to do with your loved one after the time at rehab is over.  You can get a sense of how your loved one is being treated.  After therapy is over you can see how gently (or not) staff help your loved one with activities of daily living, and how quick they are to respond to calls for assistance.  You may or may not be required to do laundry for your loved one, if the facility does not provide that service.  Sometimes this is better if you do it yourself, because things are less likely to get lost that way.  Your being there can help with your loved one's mood.  But most importantly, you can be there to monitor and catch errors or neglect.

In Z-mom's case, she had been progressing quite well and then suddenly started to decline, day by day.  No one could give me an explanation as to why.  They wrote it off to her grieving and being "too weak for the level of rehab here - she can't recover and keep up for the next day."  I would point out that she had been doing quite well and then started to decline and they would shrug their shoulders and go back to the grief excuse and say she wasn't trying.  But she was, she was trying as hard as she could.  In the end it turned out that she had a UTI and was severely dehydrated (which didn't happen overnight), to the point where she nearly died.  Neither rehab staff, nurses, nor the doctor monitoring her case noticed any of this.  I am not sure why.  And I wish I had pushed harder on all of them in the last week she was there.  A friend of ours who worked in hospice came to see mom and in fifteen minutes diagnosed what was wrong. She helped us get her moved back to the hospital, and saved her life.  Moral of the story:  pay attention, keep pushing, and call on every resource you know to help you figure out what is going on. Many people who are good at what they do are not so good at understanding how even slight imbalances can have tremendous effects on the elderly.  I did not know, but do now, that many times the only way that UTIs are diagnosed in the elderly is by display of confusion and a delirium-like state.

What this country's health care system needs (among a kazillion other things) is a good many more doctors and nurses trained in gerontology (especially to help with the death panels, amirite?).  I can't say all the things I've been watching and learning as I go along with Z-mom makes me feel good about my own approaching old age.  And don't even get me started on the insurance paperwork fallout from all of this.  I just wanna go hide.

But Z-mom, and Mr. Z, and me, and the rest of our families have made it through this far.  We are hoping for a less turbulent August and as things cool into fall, a chance to reflect, recover, and hold on dearly to those we love.

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Where's Zuska?

Perhaps my three remaining readers have been wondering just that.

(BTW, thanks Cara, for yelling at the spambots for me in my absence.  I cleared out a bunch of spam and then moved your comments since the spam was no longer there for you to be yelling at.  If you want me to put them back I will, just leave a comment here.)

The short sad story is that since the end of January, I've been beset with migraines on a daily basis.  I think I've had maybe a week's worth of days scattered here and there when I didn't have headache for at least some portion of the day.  Sometimes when Mr. Z asks me if my head is hurting I have to think about it for a minute because I can hardly remember what it feels like for it not to hurt.

Today I was good until about fifteen minutes ago, and now the headache is starting.  Yesterday I was sick all day and missed Easter with Mr. Z's parents.

Anyhoo, I tell you this not to garner murmurs of sympathy, but to let you know why this blog has been so silent.  I just have not had the energy or enough time without headache to put together a blog post (or even clear out spam).  Expect posting to be highly erratic, if at all, in the near future.

I am hopeful, though, that I may soon get the migraines under some control again.  This all started with a strained rotator cuff.  The docs figured the chronic migraines + poor posture + sleeping on left side added up to strain on the left rotator cuff.  I began physical therapy for it, and suddenly the migraines worsened despite a fresh botox treatment.  So then the docs figured that the work on the muscles, which was good for the rotator cuff, was affecting nerves in some feedback loop and causing migraines.  Get it?  Migraines lead to strained rotator cuff, and fixing strained rotator cuff leads to migraines!  Yippee!  Another factor was the absolutely bizarre winter we had, unnaturally warm and very changeable from day to day.  Rapid weather changes almost never play nice with the head.  It was all a big mess.  By now, though, I've mostly got the rotator cuff under control and am getting PT for the migraines - who knew there was such a thing?  But it does seem to be helping - sometimes a day and a half or even two days relief after a session.  And coming up soon, my next botox treatment.  Maybe by the beginning of May I'll be back to my old regular migraine schedule and can pick up blogging again!  Keep your fingers crossed!

Even though the  PT is working, and even though my insurance says I get to have 60 PT visits in a calendar year, it turns out that after you go 25 times they put you under "review".  This means they stop paying for your PT while they think about whether or not you really deserve to have health care.  One to three months later, when they finally decide whether or not you are worthy, the decision comes forth: either they pay for the PT you've been getting, or you are stuck with the bill.  Of course, you can wait three months for them to decide, but if you can go three months without PT, did you really need it in the first place?  This is known as "having generous PT coverage" in your health insurance and one should be grateful for it.  Pray to be fixed by visit 60, and not to have anything else go wrong the rest of the year. Also pray that the insurance gods consider your rotator cuff and migraine issues separate enough that they will allow PT for the migraine even if the rotator cuff seems to be mostly (though not completely) cleared up. While you are doing all this, brace yourself for the next round of begging said insurance company to cover your botox treatments, because Treatment No. 4 of the alloted four treatments is this month, and you have to convince them again that nothing else works and you really do need botox and you weren't magically cured in the past year.  Good luck!  And try not to be terrified when you see an ad from your insurance provider promising to help companies "manage" the "5% of your employees responsible for 20% of your healthcare costs".

Well, thanks for listening to the whining.  I hope to see you back here soon, with more cheerful sorts of rants and commentary.

13 responses so far

Still Here...Sort Of.

Rumors of this blog's demise have been greatly exaggerated.

I made what I thought was an April Fool's joke funee, and found out some of my readers took it seriously, which wouldn't have been so bad, except I promptly entered one of those phases where blogging became next to impossible, so it really did look like I'd packed up and gone away.  That'll learn me, as my dad used to say, not to joke about serious stuff like blog network hopping.

Anyway, I am still, in theory, blogging at Scientopia.  It's just been the usual life madness.  A picture being worth a thousand words, here's what I've been doing lately.

This morning, the phone rang a little after 9 a.m.  It was the person from my neurologist's office who they've hired to work full time on dealing with insurance companies solely on the issue of getting approval for botox treatment for migraine.  She was calling to tell me that she has left numerous messages for my insurance company's rep and has not gotten a reply, and now it's my turn to try and roust them.  The insurance company has denied my request for coverage, claiming there is insufficient evidence to show that I've failed three alternative treatment options.  The neurologist's office says they've sent them the information.  The insurance company rep says they would be happy to talk with the doctor's office, and the doctor's office rep says they would be happy to talk with the insurance company.  This game has been going on since I got the rejection letter sent out on April 16.  I have until June 16 to get my appeal completed.  I am not optimistic.  I feel like I am swimming in molasses.  I will never reach the shore, and will drown in this sticky morass of everyone saying they are happy to help me if only the other person would do x, and the other person saying they have done x, and would be happy to help me but the other person needs to do y, which is what the first person said they can't do until the second person does x, which their office shows no record of it ever having been done, but if I could call them and ask them to fax x over, and the second person says we faxed mini-x and it's their own fault if it isn't sufficient because they wouldn't let us send more than mini-x and the first person says the second person should know that we need x and the second person says I can't get the first person on the phone and the first person says just ask the second person to call us and...and my head hurts.  It hurts a lot.

Five minutes after I got off the phone with the neurologist's office, my phone rang again.  It was someone from the endocrinologist's office.  They filed a claim with my insurance company for my visit a month ago.  The insurance company has refused to pay until they receive an explanation of benefits form from my Medicare insurance.  I don't have Medicare insurance.  The kind woman on the phone tells me "they are doing this to a lot of people.  You'll have to call and tell them you don't have Medicare, and ask them if they can reprocess the claim or if we have to refile, and then call me back and let me know."

I haven't even had a cup of coffee yet, and I have at least three health insurance phone calls to make.  Plus a form I need to fill out for my in-laws.  Plus the usual paperwork for Z-mom.  I look at the cat curled up on the bed and want to crawl back under the covers and sleep till noon.

A few weeks ago I called the toll-free number Mr. Z's company provides for its employees, for a health advocate service.  The person I first spoke to was very enthusiastic and sure they could sort out the mess and help me get coverage for my botox treatments.  She then transferred me to a nurse who listened for a few minutes and then told me that I should not be calling the health advocates, I needed to file an appeal on my own, and ask my doctor to write a letter for me, and if my appeal failed, then I should come back to the health advocates and maybe they could help me then.  A week later the nice person I first spoke with followed up by email to ask why I had not filled out the paperwork she sent me and I told her about my conversation with the nurse.  Oh no, she said, we can surely help you out!  Who am I supposed to believe, the phone screener, or the nurse who essentially told me to get lost?  What does this health advocate service actually do?

What good does it do for my neurologist to employ someone full time to work with the insurance companies on trying to get approval for botox coverage, if that person doesn't even know anything about the patients on whose behalf she is working?  When I first talked to this person, she didn't know that I'd had a migrainous stroke, and she seemed unaware that my previous insurance company had paid for my botox treatments.  When I tried to explain what I did to get approval from my previous insurance company and offered to help in any way with putting together my file for this insurance company, she was uninterested.  I feel like, I am just a patient, what could I possibly know.

What good does it do for the FDA to approve botox treatment for chronic migraine, if all the insurance companies then just drag their feet and stonewall as much as they possibly can to prevent anyone from actually getting coverage?  It's not like they didn't know this was coming.  I'm sure they all knew well before the FDA decision that it was likely to be approved, and the approval was issued in October last year.  And as of the first of this year, the insurance companies were all still claiming that they hadn't figured out how they were going to cover botox, what kind of coverage they were going to offer.  Seriously?  That's how you run your business?  You wait till the last minute and make it up on the fly?  Pardon me if I don't believe that.  That $1200 I had to pay out of pocket in February is a crime.

And I just can't afford it anymore.  So until the paperwork nightmare gets sorted out, no botox for me.  I just have to deal with the increasing pain and fatigue.  And I just have to hope that I can manage to get it sorted out by June 16.

Or maybe my non-existent Medicare will pay for it.

I guess I'd better stop ranting and get going on those phone calls.  The best health insurance in the WORLD! doesn't work itself out on its own.

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The Young and Healthy Don't Need to Waste Their Money On Health Insurance!!!!

I have a friend. She has a daughter. While in college, the daughter was covered on the parents' health insurance policy.
Well, sorta. As part of her college program, the daughter had to do an internship. Hey, that's great! Great experience, maybe a great chance to get a permanent job! Except, as it turns out, the internship does not count as being a full time student for the purposes of health insurance.
My friends, being responsible parents, and additionally being parents with enough disposable income to afford it, took out a health insurance policy for their daughter. They thought they were doing the right and responsible thing for her. They did not want her to be without coverage should some unexpected and catastrophic event befall her (you know, like some sick fuck walks in to your fitness club....)
Well, as it turns out, they could have just saved their cash. My friend's daughter was unfortunately stricken with a completely unexpected, though non-life-threatening, medical condition. You might think this is the kind of thing that your health insurance would help you deal with, but you would be wrong.

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"Covered Benefit" Does Not Mean It's A Benefit That Will Be Covered

Perhaps you might have wondered why I don't blog so much lately. That would be because my full-time job these days is navigating the The Best Health Insurance System In The World!TM on behalf of my elderly mother.
You may recall that a few weeks back, her wallet was stolen, necessitating cancellation of her existing Blue Cross insurance number and issue of a new number and card. If you will recall, I explained that it appeared to providers in the interim as if my mother had no coverage.
Well, I finally received the new card with the new number. I spent a good deal of time this morning calling health care providers who had provided services to my mother during the interim period, to let them know what the new card number was so they could proceed with billing. We got the new card just in time, I thought - for as bad luck would have it, mom had another health care emergency today, and is in the ER as I type. My brother and sister-in-law are with her, and I gave them the new health care number to use at the hospital. I'm waiting for reports from them on how mom is doing.
And then I went out for a quick lunch, to get out of the house and decompress for a bit.
Upon returning home, I found a phone message from one of the providers I'd called in the morning. You guessed it: problems in dealing with the health insurance company.

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37 responses so far

A Handy Tip If Your Health Insurance Card Is Lost Or Stolen

As I recently reported, my mother's wallet was stolen last week, containing her bank card, driver's license, and insurance and Medicare cards. This has resulted in hours and hours of work for me to deal with replacing the cards, working with the bank to contest the fraudulent charges on her account, etc.
I'm going to tell you something the health insurance company probably won't, because I'm not sure that the people who answer the phones even understand that their system works like this.

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6 responses so far

Shush! This is an Examining Room!

It can't be avoided. Once a year you make the trek to the gynecologist's office for the annual exam. For various reasons, the whole experience is extremely unpleasant for me, and yet I go, because I try to take care of my health. And hey, I have health insurance! And it pays for the annual exam. Lucky me, I don't even need a referral to see my gynecologist. Though I do get to pay the higher copay for "specialists". This is especially maddening as my primary care physician, a woman I respect and dearly love, could do the exam for me - and does, for many of her other patients - but my insurance will not let her.
Ah, but I'm getting sidetracked. Let me tell you what really hacked me off about this year's pilgrimage to Stirrup-Land. Something happened that I haven't experience since I was a child.
I was shushed.
Here's how it happened.

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42 responses so far

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