Health Insurance: fighting a giant

[mthteach]

My spouse and I have had BC/BS for 28 years. When we need them the most they are not there. I requested a bedside commode for him. They told me since we got a walker, he could walk to the bathroom with it. We have tried. His legs are so weak at night, he has fell 2 times since we got it. He is dead weight and I can not pick him up. I hate to call ambulance. I get up with him 2 & 3 times in the night to walk with him to the toilet. He cannot sit up from the bed, or stand up from a chair.

Outpatient PT, OT, and ST would cost $380 a month, and home health care is $460 a month. This is with the insurance paying 80%. Where do they expect us to come up with this kind of money. The VA and Medicare pay more that BC/BS of Alabama. We have always had good insurance until now. I feel like a little pea in a huge bucket of peas and no one can see what I am going through. They say we have rules. They can put their rules where only the devil can see because God knows we need more at the end of our lives. Medicare will pay 100% of the therapies. What is this world coming to when greed is running a company like health insurance companies. He has not had any therapy for 2-3 months, he desperately needs it. It is so hard to keep faith and a happy face when we are so alone in the fight for a cure for PSP.

[easterncedar]

Argue with the insurance. Their first response is generally no, as a matter of policy. Have you tried having your husband use a urinal? Saves a step for us. Have you asked your doctor about convene?

Of course health insurance companies are out for profit, and unimaginable cruelties are the result. We don't need universal access to insurance, we need universal health care, single payer, that is. The money is all ranged against it, of course. But that's another story. Good luck, ec

[Julieandrog]

thank god for our NHS!

still a battle sometimes but we do'nt know how lucky we are.

keep strong and smiling

regards

julie x

[Jbpractice]

We needed a prescription from the doctor or the physical therapist to get a commode and a wheelchair. Please check with your local churches for donated equipment. My brother was able to receive more therapy from BC/BS when his doctor changed his diagnosis from Parkinson's to MSA. Ask his doctor/nurses for assistance when filling out request forms - they are used to working with insurance companies and know their way around restrictions. Good luck to you - I know how discouraging this is for you.

[Auddonz]

mthteach, If your Dtr writes a script for him,, Medicare and the Va will cover it, for how long I don't know. We have a supplement that covers what medicare does not here in Fl. The Va does not kick in until medicare stops payment since it would be a conflict of interest, Actually it is the pt and ot that determines whether or not further therapy will do him any good. They make the decision, not the Dtr. I would strongly suggest you speak to his Dtr. Let me know how you do.

Auddonz (aka Audrey)

[mthteach in reply to Auddonz]

Auddonz,

Where are u in Fla. We are in Dothan, AL

I still have family that lives in Bartow and Winter Haven areas

I mat my husband at Cypress Gardens in 1976 there. He was one of the water skiers.

[Auddonz in reply to mthteach]

mthteach,

We are in Ocala, about an hour north of Orlando and a little less south of Gainesville. Small world!

[mthteach]

We go through Ocala down 75 when visiting in Winter Haven. Will be passing that way in Oct.

[mthteach]

Auddonz, the VA has come through with providing 4 cases of depends to our door today. Thank God for every little bit of help. They are still processing the PT, OT, ST request. I pray they approve it through the VA. The commercial insurance (BC/BS) is too expensive on a fixed income of S.S. and Long Term Disability insurance.

I just have a hard time accepting that the insurance that cost the most is paying less (BC/BS). The VA said if approved for my husband they pay 100% and so did Medicare. The Blue Cross said they would pay 90% which left us with 360.00 a month to pay. That is a lot for us. As I stated earlier, he does not qualify for Medicare until 24 months after he has been receiving disability payments.

The S.S. office said the only disease that could speed up the Medicare posses is Lu Garrick's disease.

I thought it interesting that what I read on the computer is that Lu Garrick's disease was called Parinisinism in the olden days.