We were fortunate in that we had health insurance through Richard's work, and it was very good insurance. We had UnitedHealthCare at the time. If we didn't, we would be bankrupt. In 2008, the insurance company was billed about $1.7 million for Richard's medical expenses. Insurance companies get a reduced rate and because of that, they paid out about $700,000.
They were the ones that made all the medical decisions for Richard, which, if I had known that, I would have done things a little differently. They decided that after all the surgeries and medical procedures, that he would be transferred to Kindred Hospital. It was there that he picked up MRSA. He ended up back in the hospital because of that. It was them that decided to send Richard to St. John's rehabilitation center. It was there that his arm was broken by an occupational therapist. It was there that he was denied his antibiotics that caused the infection to flare up, get on the hardware, which resulted in the hardware taken out and shifting of the bones which will eventually lead to his ankle being fused. It is in St. John's that Richard suffered from PTSD because of what he saw and experienced there. He felt his life was in danger. It was the insurance that decided that they wouldn't pay for medical transport after they tranferred him to a place that he would need medical transport in order to get back to the doctors overseeing his care.
I was told at one point that I would have a contact person at the insurance company that would be overseeing Richard's case. It really didn't help much. I called her, but decisions were made that were beyond her control.
We were told by an representative of the insurance company that a scooter would be covered if a doctor ordered it, but when the doctor ordered it, it was denied. This kind of thing we dealt with all of the time.
I feel that medical decisions should be made with the family involved. If they would have said to us, "Richard is in a period of time where he cannot receive rehab and he has no need for hospital care, he needs to be in a facility that can meet his needs. These are your choices." That was never done. When we complained to them, nothing was done for extended periods of time. It was finally, in the days just before he went to HealthSouth that they came around and said that we could choose the facility that he would be in. Because of that, he started getting the care he needed, and he began to improve.
We were told that our out-of-pocket expenses would not exceed $2,000, but the EOBs specifically had listed that we were to pay over $10,000. When Richard questioned it in 2009, they said those things were not covered. When he showed them that they were, they said that would check into it. We never heard from them about it. I don't understand this at all so any insights about this, I would love to hear them.
If I had been able to pay for his medical out of pocket, the decisions we would have made would have been very different from what the insurance company decided. Would it have cost them more money? We will never know. We never got the chance to make those decisions, and yet we are the ones that are living with the consequences of them.
The bottom line is that the insurance company doesn't care whether your loved one lives or dies. That is not their job. Their job is to provide healthcare for the cheapest possible cost. I am grateful that I had insurance, but I wish I didn't have to have it. I wish I had enough money in the bank that we could pay for the best healthcare that was available.
If you are going through something like this, my advice is to ask questions. Ask why they need a transfer to another facility. Tell the insurance company that you would like time to check the facility out - maybe 24 hours, so you feel comfortable with the choice. If you get in a bad facility, ask to get out of it as soon as possible. Every day damage is done that cannot be undone. Be at each facility as much as you can be. Believe the patient about what is happening there. Take food in if you need to. Advocate, advocate, advocate. That is what I would have done more forcefully. And as a final resort, call 911.
No comments:
Post a Comment