Insurance – Don’t Get Me Started! Part Two

But, the best is yet to come…. I’m not joking!

The Orthopedic Surgeon puts my arm in a cast and now l will need additional physical therapy when the cast comes off.  Who is going to pay for that since I’ve exceeded my lifetime maximum?  Do you see where this is going?  How would a stroke victim or any type of serious injury get the care needed?

Who wrote these policies? 

When was the last time they were reviewed or updated? 

How many other people had been thru what I was going thru? 

Something had to be done. Changes had to be made. Maybe this was another reason I was still here. Maybe this was another part of my journey.

I continued to get all my information ready.  I was still upset at the way this was handled by a single phone call.  My appeal’s hearing was scheduled and since it was my husband’s insurance he would need to be there, a day off unpaid.  I was required to send all the paperwork that would be presented ahead of schedule.  I can’t tell you how many times I practiced it in my head.  I wanted to not only take care of myself, but make a difference.  Many people had heard my story at John’s work and they too had issues, but never pushed the issue this far.  At this point I had nothing to lose, but everything to gain.

John and I arrived early. We were left in a small room till they were ready for us.  When we entered the room there was a large table seated with an attorney, several elderly gentlemen, the union board members and a young lady.  The first shock was when I walked in with my cast.  Several who knew me and had been involved with my case were concerned as to what had happened.  I told them I did it trying to do my own physical therapy.  The room went silent. They proceeded to hand out the paperwork I had prepared and had sent earlier while the attorney informed me that the hearing would be recorded.

As I began to talk and go thru each page, I noticed they didn’t have everything.  I questioned where the other pages were?  The meeting was stopped and another set was made for everyone, this was my time and I was going to have it.  As I told my story I tried hard not to cry, I was afraid if I did I wouldn’t stop, so I kept going.  Several times the comment was made, if we made an exception for you, we’d have to for everyone.  Finally, I had had enough.

I told them that I didn’t want to be an exception, I wanted the policy changed! 

No one should have to go thru what we had gone thru, what we were still going thru. 

Did they not want people to get better?  Did they really believe this couldn’t happen to them?  I stood and looked at the elderly gentlemen and recalled my time in the hospital, men there ages were there from strokes and they looked just like me, but they weren’t going home, they were going to assisted care facilities.  I could be them, their wives, husbands, children, think of me as that when you make your decision.  We thanked them all for giving us the opportunity to plead our case and left.

Several weeks later we received a letter to us and a new addendum for our benefits book.  Everyone would now be covered under your major medical plan for all dental and physical/occupational/speech therapy if it were related to a life threatening diagnosis.  This meaning the maximum the insurance would ever pay for anything for your entire life.  It also was dated effective to the year prior to my diagnosis.

I had won, not only for me, but for thousands of others.  I received many calls, emails, and John was thanked by everyone at work.

You see insurance companies are run by human beings just like us and everyone has the right to an appeal….policies can be changed, exceptions can be made, get involved, fight for your life, I did!