2BorNot2B
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I've lived here for 25 years and have never heard such a term used. I find it offensive and an un-called for remark, especially on this thread!
Thanks ..but no pill required!
2b
International Shannon
- Thread starter InternationalShannon
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I've lived here for 25 years and have never heard such a term used. I find it offensive and an un-called for remark, especially on this thread!
Thanks ..but no pill required!
2b
InternationalShannon
Veteran
thank you for all your nice posts a thousand times. im going to post what i posted on my facebook so it might be redundant since lots of you are friends, but i am seriously sleepy and need a nap. I am so, so grateful for all the love. Ok, long boring post, and yes, I am still alive. ETR: ????? Number two window will be without me for a lot longer, sadly.
Here's the long and longer of it :
Hi everyone - - I am back home from an entire month inpatient treatment to make my heart all better. i had no access to computers or phone unless it was basically sneaking.
I have not checked my email in a whole and not the messages here. To the people that sent me letters, especially Greg, I am so grateful. I am sorry I didn't really write anyone.
I am extremely overwhelmed and was sent home after the insurance denied all the appeals. the medical team was adamantly against discharge because there were four stages of treatment to complete and i never got off the first stage. stupid insurance. But at 8,000 per week, you can imagine I couldn't stay long after that happened and no time for more appeals.
So, yes, I am back home, very overwhelmed and frustrated that i couldnt complete what was needed to get "all better" and I cannot live the way I was living before, with bad eating habits , a broken heart, literally,emotional stress and no healthy way to cope with it, too many prescription pills to keep track of, and behavior that was not ethical.All of those things contributed to the precarious position my life stood in before I left my house.
I will continue extensive outpatient treatment 5 full days per week here in charlotte, for who knows how long possibly months. if my situation gets worse, i'll be sent back to the same place i went. I am hoping I will learn coping skills, excercise and healthy eating and surround myself with supportive people (like all of you) so that my lilfe does not hang in a delicate balance. Hopefully that valve will get stronger and surgery will not be needed, but I absolutely have to keep focused to keep that heart going.
I did meet some other patients at the center who I am so happy to be friends with now. We were kind of in jail. ha ha.
I just need time to adjust back to normal life, or as Greg says, "find a new normal"
I pray that I do not have to go back to Florida and that I have the strength and willpower to carry through and be more mindful of how my actions affect my health. I will do my best to stay motivated and eat healthy, deal with stress by actually eating (the anxiety made me lose my appetite as well as flippant use of prescription meds, or stopping them suddely, not drinking water, not excercising, and avoiding that stress until it went out of control)
i am not "all better" but I can be. I just need some time to adjust to all the freedom I have and using it wisely. I promise I will read and reply to everyone's messages when I am acclimated to being back in the real world - being able to go outside without an escort , having vitals taken constantly, having a cell phone again, a computer, not having a nurse checking in on me every hour, even at night, not having to share a bathroom with four other patients, choosing my own food and actually not having someone over my shoulder forcing me to eat ALL of it, not having an escort everywhere i go in case i hurt myself or whatever, and being able to go outside when the day is beautiful instead of watching through a window.
Most of all, adjusting to having my kids back asap, they are not here right now because I still cannot technically care for myself and will be in the hospitalish environment again all day every day but still getting to go home. My husband works every day, so there is no one to care for them until Monday if they are here.
Please don't be upset if I dont return calls or texts right away, I'm kind of overwhelmed, but I still love you allllll the way to the moon and back, first class for sure.
I'll get back to my normal self soon. I'm kind of feeling a welcome isolation washing over me. I'll be in touch soon.
I love you all!!
Here's the long and longer of it :
Hi everyone - - I am back home from an entire month inpatient treatment to make my heart all better. i had no access to computers or phone unless it was basically sneaking.
I have not checked my email in a whole and not the messages here. To the people that sent me letters, especially Greg, I am so grateful. I am sorry I didn't really write anyone.
I am extremely overwhelmed and was sent home after the insurance denied all the appeals. the medical team was adamantly against discharge because there were four stages of treatment to complete and i never got off the first stage. stupid insurance. But at 8,000 per week, you can imagine I couldn't stay long after that happened and no time for more appeals.
So, yes, I am back home, very overwhelmed and frustrated that i couldnt complete what was needed to get "all better" and I cannot live the way I was living before, with bad eating habits , a broken heart, literally,emotional stress and no healthy way to cope with it, too many prescription pills to keep track of, and behavior that was not ethical.All of those things contributed to the precarious position my life stood in before I left my house.
I will continue extensive outpatient treatment 5 full days per week here in charlotte, for who knows how long possibly months. if my situation gets worse, i'll be sent back to the same place i went. I am hoping I will learn coping skills, excercise and healthy eating and surround myself with supportive people (like all of you) so that my lilfe does not hang in a delicate balance. Hopefully that valve will get stronger and surgery will not be needed, but I absolutely have to keep focused to keep that heart going.
I did meet some other patients at the center who I am so happy to be friends with now. We were kind of in jail. ha ha.
I just need time to adjust back to normal life, or as Greg says, "find a new normal"
I pray that I do not have to go back to Florida and that I have the strength and willpower to carry through and be more mindful of how my actions affect my health. I will do my best to stay motivated and eat healthy, deal with stress by actually eating (the anxiety made me lose my appetite as well as flippant use of prescription meds, or stopping them suddely, not drinking water, not excercising, and avoiding that stress until it went out of control)
i am not "all better" but I can be. I just need some time to adjust to all the freedom I have and using it wisely. I promise I will read and reply to everyone's messages when I am acclimated to being back in the real world - being able to go outside without an escort , having vitals taken constantly, having a cell phone again, a computer, not having a nurse checking in on me every hour, even at night, not having to share a bathroom with four other patients, choosing my own food and actually not having someone over my shoulder forcing me to eat ALL of it, not having an escort everywhere i go in case i hurt myself or whatever, and being able to go outside when the day is beautiful instead of watching through a window.
Most of all, adjusting to having my kids back asap, they are not here right now because I still cannot technically care for myself and will be in the hospitalish environment again all day every day but still getting to go home. My husband works every day, so there is no one to care for them until Monday if they are here.
Please don't be upset if I dont return calls or texts right away, I'm kind of overwhelmed, but I still love you allllll the way to the moon and back, first class for sure.
I'll get back to my normal self soon. I'm kind of feeling a welcome isolation washing over me. I'll be in touch soon.
I love you all!!
2clippedwings
Veteran
Thanks for bringing us up to speed on your treatment. I can foresee your biting wit relating this trying time on your blog eventually. Speedy recovery to you SNN
Dog Wonder
Veteran
Keep on Shannon.
Too bad you missed all the Gnome jokes on Get Fuzzy while you were in Jail.
It started with a metronome.
Too bad you missed all the Gnome jokes on Get Fuzzy while you were in Jail.
It started with a metronome.
Dont call me Shirley
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Welcome back and welcome home, SNN! Best wishes for your recovery. It's wonderful to know that you are doing better. Too bad that Wendy's will have to struggle along without you for a while longer.
BTW, "surely" someone out there knows a good version of the joke about the docor and the health insurance CEO trying to get into Heaven. ( I only remember the punch line)
BTW, "surely" someone out there knows a good version of the joke about the docor and the health insurance CEO trying to get into Heaven. ( I only remember the punch line)
N965VJ
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Shannon, I’m glad to hear you’re back home even, if under less than favorable circumstances. All of us here wish you a speedy recovery!
InternationalShannon
Veteran
I really am not feeling warm fuzzies here is why. I got this letter and here is how it went. loosey interpreted.
Dear International Shannon
Unfortunately, your benefits, specifically your out of pocket max was miscommunicated and/or out of date We apologize sincerely for the error., Please remit 2 million billion dollars to your provider, JAIL and/or ISOLATION ALLEY, to continue your treatment plan.
Additionally, you have been placed on an alternate program to better suit your individual needs due to failing to meet certain medical requirements communicated to us from your provider.
( insert f'd up list of basically everything right before you DIE updated 1/28/09)
Should the medical necessity to continue hospitalization arise, we will be happy to review your file and help you on your path to healthy living.
Please don't hesitate to contact us because at Wendy's Health Care, WE CARE about your as an individual and strive to preserve the most precious gift of all, life.
Signed,
[b]Brenda Blowhard
Case Manager[/b]
1-800-FBOMB
O mygosh..... this f'd up little game of "just the tip" that this insurance is playing is not amusing. And do I even need to point out that even though they care about me as an individual, this is obviously a FORM LETTER ? They dont even take out the bolds. Of course, I changed things and didn't copy the letter word for word, but seriously.
That is all I have to say today. I am still not answering my phone because I really dont think anyone deserves the string of frustration I am feeling right now, however, if it continues, I'll have another clot and get sent back anyway, so that they can save my life, send me to a surgery and then call in the middle of my heart being ripped open and then declining to close the wound because my effing insurance just cut out. Seriously, with odds like that, I dont even need to be high to get a giggle out of the absurdity of this.
It's a jacked up game of Simon Says and Simon is wasted and there is more than one Simon and they all say something different and they all have short term memory.
I know life could be worse, I know there are people worse off. I am so sad for the lack of miracle yesterday's passengers didn't get... so I know I shouldnt complain. I am so sorry that happened.
I do wish Brenda Blowhard and Larry Denysalot of PSYCHEYoureNotCoveredville would just be honest and rally for the company motto at Wendy's Insurance to be "What? We're all gonna die anyway so just get it over with. PS Bend over."
AAAAAAAAAAAAAAAAAAAAAAHHH!!!!!!
That is all.
Love you all the way to the moon and back even though I am bitter and antisocial.
2BorNot2B
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Well ......... HAPPY VALENTINES DAY Shannon !!!!
There now .... feel better?? Hope so!
crownroyalonice
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Dear Snn,
Good to see you posting! Hope you are taking it easy. Prayers coming your way. Hang in there!
Good to see you posting! Hope you are taking it easy. Prayers coming your way. Hang in there!
AtlanticBeach
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Hi Shannon,
Ordinarily I would PM you about this, but I hope that this message will help all who read this Board.
Typically when a patient gets a denial letter for major care, it is due to the treatment not matching standard protocols for the diagnosis. It is proper to confirm that the correct ICM diagnosis codes were used for your condition. Once the carrier has the diagnosis codes, the clerks at the company refer to their guidebook, now a computer screen, as to the coverage allowed for that code. That information should have been made available to you prior to your admission. If the allowable in-patient time or procedures were insufficient, your doctors or their staff should have called to speak to an appeals nurse. This may also require written documentation.
I'm still perplexed as to why an out of state referral was made for your condition. There are certain Centers of Excellence in medical care in this country. I know of three Centers of Excellence in Cardiac Care within 200 miles of CLT (and the best in the southeast is probably BHM, believe it or not). There are several in Florida, but as I recall your working diagnosis, none of those highest level facilities are near MCO.
Some insurance contracts allow for an Alternate Benefit Provision. That means that if there is a similar (not identical results) protocol that is less expensive, the carrier may elect to pay the amount equivalent to the least expensive option.
Then there is the issue of whether the facility in Florida is in-plan with your carrier. This can have different meaning based on whether your plan is an HMO, POS (That's Point of Service for the uninitiated) or PPO.
So, I hope that your diagnosis matches the codes that were submitted. Start there and then follow the paperwork to make certain that everything is consistent. Good luck and I hope that you feel better soon.
Ordinarily I would PM you about this, but I hope that this message will help all who read this Board.
Typically when a patient gets a denial letter for major care, it is due to the treatment not matching standard protocols for the diagnosis. It is proper to confirm that the correct ICM diagnosis codes were used for your condition. Once the carrier has the diagnosis codes, the clerks at the company refer to their guidebook, now a computer screen, as to the coverage allowed for that code. That information should have been made available to you prior to your admission. If the allowable in-patient time or procedures were insufficient, your doctors or their staff should have called to speak to an appeals nurse. This may also require written documentation.
I'm still perplexed as to why an out of state referral was made for your condition. There are certain Centers of Excellence in medical care in this country. I know of three Centers of Excellence in Cardiac Care within 200 miles of CLT (and the best in the southeast is probably BHM, believe it or not). There are several in Florida, but as I recall your working diagnosis, none of those highest level facilities are near MCO.
Some insurance contracts allow for an Alternate Benefit Provision. That means that if there is a similar (not identical results) protocol that is less expensive, the carrier may elect to pay the amount equivalent to the least expensive option.
Then there is the issue of whether the facility in Florida is in-plan with your carrier. This can have different meaning based on whether your plan is an HMO, POS (That's Point of Service for the uninitiated) or PPO.
So, I hope that your diagnosis matches the codes that were submitted. Start there and then follow the paperwork to make certain that everything is consistent. Good luck and I hope that you feel better soon.
AtlanticBeach
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Bob, good questions. Since our goal is to turn this into an instructional thread for all, let's look at the issues you raise.
Yes, denial of even the most simple and appropriate claims occurs regularly. United Healthcare is the worst in my experience. Others will "lose" submissions. When we consider that typically only 60 to 65% of healthcare dollars go to claims, we realize the huge cost of administration.
As to $18K in non-coverables, the diagnosis code or codes would be key. There are also increasing limitations to certain services in some plans, especially technology, due to utilization that is not medically necessary. I see it all the time as a provider. MRIs get ordered for conditions when they aren't indicated. The frequency of tests also strains credibility.
The second issue you raise about improper billing by facilities is absolutely key. Many hospital medical bills are works of fiction. When I was in a hospital on which I was medical staff, almost a third of the bill was incorrect. I feel badly for people who can't read these complicated multi-page billing statements. Another example (different hospital) was my aunt. She passed away and both the hospital and a surgeon submitted bills to Medicare for a procedure that had been scheduled for the week after her funeral. As Trustee of her estate, I got the bill and went ballistic. By the way, Medicare paid for the procedure, but I made certain that the monies were refunded.
Being an informed consumer is key. Many insurance plans have slight modifications in the policy each January 1. It drives my office staff crazy, because they have to keep up with all of the changes. Our practice deals with both medical and dental insurance, so we get a double whammy. It's got to be terribly difficult for the general public. In Shannons case, even if a union contract has certain requirements, the carrier can make modifications based on Prevailing Medical Care regarding some procedures and type of care.
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