Fighting Period

One of the worst parts of the stroke I think was dealing with the health insurance.  That’s sound really crazy doesn’t it.  It happens and when it was happening to me I wondered at people who did not have good insurance or a strong support system like I did.

Shortly after Scott was in Neuro ICU the social worker and an intake Nurse for a Rehabilitation hospital came to see me.  They discussed with me how things should go for Scott, leave Neuro ICU, move on to the Rehabilitation Hospital, then on to a rehab facility and home with home health care.

WOW easy sounding, logical sounding, medically sound because the Doctors, nurses, therapist all agreed yes this should be the plan. Scott was to get the highest level of rehab because he was so physically active and completely independent before the stroke.

I researched the rehabilitation hospital and it seemed great, it was in the network, covered, all the junk it needs to be so off we go.  Then I found out up front and in my face how it really works.  When the social worker mets you very early in the morning to tell you someone in an office , somewhere who are have never seen, touched, examined your husband is the one who decided he cannot go where his huge team says he must go.  It is unreal, and I mean it on top of exhaustion, worry and eating to much hospital cafeteria food you try to figure out what happened…what does this mean.

You try to be logical.  You say I have the highest coverage offered.  I have had the highest coverage offered always.  I pay the highest premiums so I can have the highest coverage.  Why ???  In case one day something bad happens like your husband has a stroke and it is large and it is bad, and it is deep in his brain and he almost dies but does not.

So then your team starts figuring out how they are going to change this situation.  I call my boss, my HR benefits person and anyone else who will listen.  Then the hospital advocate tries and gets shot down but the evil, invisible power that is making life and death decisions based on something other than need and medical necessity.

He was denied, denied, denied, denied, yes folks 4 times each time a little more wind was taken out of my sails.  By the way at this time he was progressing and they got him off the vent and put a trach in.  NOW everyone is excited , they have to approve him now they say there is very specific weaning from a trach..the rehabilitation hospital is only 1 of 2 places that do it.

They denied him.  Don’t worry they say all he has to do is fail the trach test 3 times.  I filled with wonder and fear because I was told you don’t do the trach test right away.  The first test he lasted 45 minutes, then fail.  The second test he lasted 2 minutes went into oxygen failure and his BP spiked to …yes STROKE LEVEL.  Honestly I cannot even remember the 3rd test, but he failed.

DENIED.

What was this crazy world I was in please just let me go back to my life I do not want to be here and listen to this and then make decisions.  They appealed and it was approved.

Dear god, I know there is a special place in either heaven or hell for insurance companies.

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