Tags
My hunch is that we all go through the same things. I don’t care how you label yourself. You Tough Guys/Bitches can hide behind your personas for only so long before you break down too. Our loved ones are our loved ones and we care. Big insensitive and indifferent corporate bureaucracies will always procrastinate in their favor.
Right now, I’m working on one biggie, two medium-sized and and one small nagging chronic dramas. First, my wife has a hard knot on the right side of her neck, where fluid accumulates when she chews and swallows. I don’t know what the Hell it is but I don’t like it.
“Do you think it’s cancer?” she asked me, as if I were an oncologist. The little voice in the back of my head is saying, “I wouldn’t rule it out”, but I can’t say that. She sees a dentist this afternoon and a doctor tomorrow morning. The dentist can rule out a tooth issue. The doctor can maybe do a needle biopsy and get an answer, but I think he’s going to order a CT scan, which means more worrying. I lost a dear cousin to head and neck cancer four years ago. We shall see.
Dramas #2 and #3 involve those perennial nemeses, insurance companies. We have the health/medical insurer who is denying a claim, pending I show medical necessity for wisdom tooth extractions done under general anesthesia in a hospital OR. My oral surgeon, highly respected by his peers, deemed it necessary and I have his notes. I’m waiting for the policy exclusion clause from my dental insurance policy, a group plan to be furnished by my employer, since I don’t have a copy of the policy. Once I get the documentation, the appeal should work in my favor. It just means the insurance carrier can hold on to the money a little longer, collect interest on the reserve and leave the hospital and anesthesiologist standing there with open palms, as if they have no expenses to pay of their own.
Drama #3 involves the long term disability carrier who hasn’t paid on my disability claim since it began in November. I had been unable to work for the last six months previous to back surgery because I had a rotator cuff repair and my back pain, necessitating the surgery made work impossible. I can’t work now because I had a spinal fusion the week before Thanksgiving. This procedure has a high probability of failure if it doesn’t heal properly and completely, so I am not rushing back to work where any bend, lift or twist could send me back to where I was before the surgery took place. Pretending to be a fabulously wealthy billionaire who can live off his investments is fun, but I live in the Real World in Anytown, USA. I complained to the Bureau of Insurance yesterday and the insurance carrier promised they would deal with my claim today. We shall see.
Drama #4 is the continuing saga of Number Two Son, an Asperger’s syndrome patient, who hasn’t quite figured out that his father wants to know that he is safe, healthy and relatively happy. This would require a regular phone call or text, letting me know where he is and that he’s doing OK. The Prophet Elijah could fly across the heavens in a chariot of fire before he calls. So Easter is coming up, a family time and word from him would be nice.
I’m praying my wife’s neck knot is no biggie, the insurance companies will pay their respective claims and my son will call or text or visit.
Stay tuned.
Dispatches From Dystopia 
As far as drama #2 goes, I have a suggestion that always helps whenever my insurance companies have tried to deny claims. First, call the insurance company and tell them you want to speak with the HIPAA Compliance/Privacy Officer (I once had an insurance company try to tell me they didn’t have one… By federal law, they have to have one).
Once you’ve got that guy on the phone, ask for the names AND credentials of every person accessing your record to make that decision of denial. By law you have a right to that information.
Right around this point is when they’ll try to feed you excuses, stall for time, etc. Keep insisting on that information. They will almost always reverse the decision surprisingly quickly, rather than admit to you that the committee is made up of low-paid high school graduates, looking for “criteria words,” making the medical decision to deny your care.
Even in the (extremely) rare case that the decision is made by a medical professional, it is unlikely that it is made by a board certified specialist in that field. Insurance companies don’t want you to know that.
If they refuse or give you the run around, tell them you’ll report them to the US Office of Civil Rights (OCR.gov) as a HIPAA violation.
And that goes for any treatment or test that your doctor orders. Any time they try to deny you, follow those steps. I’ve never had a denial stand. I have a friend who said he once had the insurance denial stand, but that’s it. It’s very rare that the denial won’t be reversed, regardless of their reasons for it.
Sounds like a lot to deal with. Hope everything work out well. Thanks for commenting on my blog!!
You are welcome. It’s all coming together, but that’s another blog post.