Posted on 2015/11/28 by LKH
I have been ill for about three months now,
But for the sake of this article let me back up a bit. In 2006 I was diagnosed with congestive heart failure, pulmonary hypertension, I already was diagnosed with diabetes, asthma, COPD and emphysema.
The illnesses in 2006 came so fast that I ended up on disability with a medical retirement and probably will never work again,
Usually every fall, I end up getting very ill because of the allergens in the air, the people burning their leaves, and many other environmental factors like changing climates and weather, dampness in the air etc, etc
So when I got sick this time, I thought okay, do the same things and treat it like always, breathing treatments, fluid pills, allergy medications and many doctors appts. So imagine my surprise when I couldn’t get better. I kept getting worse and worse. Dr appt after Dr appt and an ER visit and I keep hearing the same thing, it’s not your heart. You are fine, there’s nothing we can do for you.
Then why do I have 45 extra lbs of fluid on me, I have blisters on my legs from the edema and a wonderful insurance company (said tongue in cheek) that is fighting me at every step of the way.
I have an insurance company called Care Improvement Plus. If you live in the state of TX and you are under the age of Medicare Retirement age,. You cannot get a traditional Medicare supplement. You have to get what is called a Medicare Replacement Plan. Let me just say this. They are some of the worst insurance policies I have ever had to work with. When I was in the workforce my job was to process and administer, prior authorizations and referrals for a huge regional hospital in our area and one of the clinics that they had as well as Worker’s Comp.
I was good at what I did I was a go to person for the hospital and if someone couldn’t get an auth or referral, I usually could. I worked with many insurance companies as well as worker’s comp and Tertiaries that had affiliates with attorneys and car insurance companies and those kinds of things. I NEVER came across an insurance company that worked so hard to NOT pay something as my insurance company that I have now. Not even Worker’s Comp. They were a breeze compared to what I deal with now.
I must give you a disclaimer of this thought: No matter how horrible that they are, i am thankful that I do have insurance. The majority of my medications are paid and I will give them that. For that I am eternally grateful.
this maze I struggle with every day in my insurance company is getting to be a joke. I just got out of the hospital and have been under great scrutiny by my insurance company, by doctors, nurses and every part of my being is that “what part of this is right?” Health care is a privilege though, NOT a right and while I know this, I still struggle with the fact that every single thing that happens with my body is nothing new to me. Each doctor I meet, each nurse I meet has to be told the entire story every single time. When does it change that the patient’s rights do come before the hospitals, the insurance company and everything that goes with it. So, I have a bit to say about what has happened, and what didn’t happen. In the mean time, I’m fine for now. I get to look at all of my EOB(s) and decide what can happen from here.
My goal with this article, first is to let you know that
Become an informed patient
Know your medications, know your diagnoses
Become familiar with Medical Terminology
Do not take no for an answer
I don’t understand why they have so many rules and regulations and fight patients as each step of the way.
How does a suit over 2000 miles away from me, can make decisions about my health care,
So now that I am out of the hospital, I need to weave this maze of insurance and find the very best insurance being disabled in America, in Texas will let me choose.
Pray for me now.
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