Insurance – Don’t Get Me Started! Part One

We have great insurance I guess you could say we are one of the lucky ones.  My husband has worked hard to make a good living and provide for his family.  But, without good health there is nothing that can prepare any family for a brain tumor.

Everything was fine at first, as long as I was in the hospital.  Maybe I should say covered by the insurance that is.  At least that is what we thought.  I was in full physical therapy trying to get my body back, remember I had right side paralysis after the surgery.  The harder I worked the better I got, but also the more it cost.

Does anyone really know how much coverage they have?

Or what is covered?

Sure if we fall, break an arm; get some stitches, but long term treatment care.  We just present that card when we arrive at the medical provider and hope the majority is paid right?  If not, then we try to pay it.

One day while leaving physical therapy I received a call from my insurance, was I aware my benefits had exceeded the maximum?  What?  You’re kidding right?  No, they weren’t!  There was an oversight and my insurance was a maximum lifetime of $15,000 for physical/occupational/speech therapy combined.  Now anyone who has had any therapy at all knows that is nothing.  Not even close for my type of recovery.  What do I do now?

I began reading the insurance booklet, making phone calls, asking questions.

Amazing the things I found out…

Unless I appeal my insurance company, that’s documented in the small print on the back or second page of your explanation-of-benefits you receive when a claim has been paid, then I was responsible.  Of course the appeal would need to be in writing.  Remember, my right hand is partially paralyzed, so I would have to do this with my left hand? Just what I need to hear with all my other problems.

So I start the appeal process, writing letters, making copies of my bills, getting doctor’s orders, pulling it all together and scheduling a hearing with the Board of Directors to hear my case.  Oh, and while I’m at it, my dental will also be exceeded if I do all the required dental work in order to have radiation.  So let’s get-er-done!

Since I wasn’t able to do physical therapy, (I was also doing pool therapy, your body cooperates much easier in water), I decided to join the community center and try doing it on my own.  Well, I could continue my PT, but of course I would have to pay for it.  Heck, I didn’t know what I was going to have to pay all ready; you think I could afford to continue it at this point?  The first few days I was impressed, I could do the equipment, the pool was set up where I could just walk into it, they even had an area you could walk against the water for knee injury or replacements.  So everything was going great till one day I fell going to get my towel and broke my right arm.  YES, my bad arm!  Can you believe it?  This could only happen to me.  So now we make a trip to the ER or Urgent Care.  I think I even paid for their new addition.  After the X-ray and determine it is broke they wrap it with a splint until I could get into the Orthopedic Surgeon.

But, the best is yet to come….