Saturday, November 6, 2010

Hard Choices

In the U.S.A. we have 4 choices in health care:
1.Medicare for the poor, disabled and retired.
2.HMO's the least expensive private insurance. Clients must use doctors within their network, a long and difficult referral process for specialists and many prescriptions are not covered.
3.PPO's the most expensive private insurance. Clients choose their doctors and most prescriptions are covered.
4.Pay for your own medical services out of pocket.

As a child my father taught me that the most important thing when providing for your family was to make sure you had insurance. Life insurance, car insurance and health insurance were all a must. Having a sister with Cerebral Palsy made the importance of having insurance a reality.

As a young mom I was faced with a difficult choice of staying home with my children or working to provide health insurance for my family (my former husbands employer didn't provide health insurance). I chose to work even though childcare took 75% of my salary, I was pretty much working for the insurance benefits!

I have been very fortunate over the past 20 years that my employer has provided me with a PPO with very minimum out of pocket expenses and great service. Last Spring I was faced with a very difficult decision. My PPO would now cost me $360 dollars a month to keep. Now add the fact that I was just informed that I would be taking a 20%pay cut (roughly $1,600 a month) and the decision was made for me. Unfortunately for me my budget is a bit tight because of my recent divorce and purchasing my home from my former husband at the top of the market. I couldn't sell my home if I wanted to because my home took a 33% drop in value because of the recession. Don't get me wrong, my former husband deserved every penny, just bum luck on the timing of the recession.

So here I am with an HMO and a bit concerned over the care I might receive. I tried very hard to be proactive. I chose a group that refers patients to my neurologist,as most POTSy's know a good neuro is the key to getting better. I also made my general practitioners appointment the first week that my new insurance was activated (which was a real hassel in itself). I had my prescriptions changed over, and one denied the first day grrrr.....! I requested the referral to my neuro and was told that this group doesn't refer to my neuro! I was told that they would attempt the referral process and that was the last I had heard about it.

I have been very blessed to have been in great health (for a POTSy)this past month, so I had not given the referral process another thought. Which was a huge mistake on my part. With teaching 32 students and a few "special" students I've been a bit preoccupied. I still have to laugh (rather than cry) at the irony, I have 12 more students and get paid 20% less. Now some would say you're working less hours, NOT. Prepping for 32 is much more time consuming, and hence I'm putting in more hours!

Well, all that stress and longer hours is finally catching up with my POTSy body. All week I've been watching the warning signs that my body was on the down swing, shortness of breath, very purple hands and feet and extreme fatigue, but I'm a push through it type, so I kept working. On Thursday my body said "that's enough, you need to rest!" So I requested a half day sub and went home and took a much needed nap. When I woke up I decided to call my new doctor and check on my referral. I was told it was denied. Being too sick to deal with the stress of making numerous phone calls I called it a night.

On Friday during my lunch I called the patient advocate with my HMO to find out the process of fighting my denial. My advocate was actually very nice after I explained the reason for choosing her group. She told me she would do a little investigating and get back to me. A few hours later she told me that my neuro was never on the referral list and gave me the group he was connected with. She told me it would be a long process to switch and that she would recommend seeing their neuro and hopefully get the ball rolling on the referral process.

I call the neuro that I have been approved for and attempt to make an appointment. I'm put on hold and then told my appointment date would be December 2nd. I tell them I'll take the next available appointment, and I'm told that December 2nd is the next available! My voice goes up an octive and I explain that I have a rare disease and I can feel my body getting ready to shut down, can they please fit me in somewhere? I'm told "So sorry, this is the best I can do". I become panicky, because I know I'm on the road for a trip to the ER and an unwanted vacation in a hospital room without a view! In a shaky voice I ask the poor man on the other end of the line "So if I end up in the hospital who do I tell them my neuro is?", he responds, "You don't have a neuro, I'm sure they have someone in the hospital there who can help you." I start laughing hysterically (I'm sure at this point the man must have though I needed a psychologist and not a neuro). He confirmed my appointment time for December 2nd, and quickly got off the phone with me.

So here I sit, without a neuro, feeling very POTSyish and abandoned by my insurance company. What's this POTSy girl to do? Those of you who have shared the past four years with me know that God has carried me through a difficult divorce miraculously. He's helped me recover from an eating disorder that consummed every thought. He has comforted me through the death of my father and He gave me a quick POTS diagnosis and an amazing neuro. He will carry me through this bump in the road as well. I will give this to God and use the wisdom and resources He has provided me to get through this. This is nothing compared to losing the love of my life through a painful divorce.

Still inspired,

What would difficulties be without my favorite verse.
Jeremiah 29:11
I know the plans I have for you, declares the Lord, plans for welfare and not for calamity to give you a future and a hope.

1 comment:

  1. It's really sad, and scary, that even when there are sick people out there willing to do all it takes to get better... that it's the health system keeping you from getting that way. I am so sorry you are going through this, and I am hoping you're health holds up until Dec. 2... it's my birthday so that will be my wish to you! lol. I also hope this guy will be a good neuro for your as well!