Pre-Thanksgiving and Insurance Woes

I’m in Thanksgiving mode.

Yesterday, I was “stuck” at home waiting on a delivery.

While I was home I made my “best in the world” cranberry dish.

I also baked pumpkin bread.

I also worked on a potato casserole.

Last night my youngest son arrived home from college for the holiday weekend.

My daughter (and friends) will arrive today.

[My oldest son, sadly, will not be able to visit until January.]

As I was baking yesterday, I had the air conditioning running because of the heat.

This is what Thanksgiving is like in Southern California – air conditioning!

At the same time I’m busy with family/holiday activities,

I’m also trying to work with my medical insurer Blue Shield of California.

Insurance companies don’t like to pay for physical therapy.

And, to be honest, most people don’t need ONGOING physical therapy.

If you’re injured/have surgery, a physical therapist helps you get well again.

Physical therapy is a temporary thing.

For those of us with permanent disabilities, however, it is a very different situation.

I will never have much use of my arm.

I will always need someone to move it for me since I can’t move it on my own.

Having a PT do this, keeps me from losing the limited mobility I do have.

It also prevents the muscles attached to my arm and shoulder from atrophying and creating worse problems.

When I don’t have regular PT visits, I regress rapidly.

My pain increases tremendously due to severe muscle spasms.

It’s a downward spiral.

You would think insurance companies would see the benefits of ongoing care for permanently disabled people.

But, medical insurance is never easy in 2014, is it?

My doctor’s letter proving “medical necessity” apparently wasn’t quite enough to satisfy the insurance company.

(Yes, even though they do know about my nine surgeries.)

Instead of asking my doctor for more information, Blue Shield of CA simply stopped paying my PT bills.

Now, I’m in the middle of a mess … PT bills, medical insurance “committees” who don’t know me, but are determining whether or not I’m really disabled, my doctor, and my physical therapist.

My doctor is re-communicating with Blue Shield of CA.

Will good and right prevail?

I wish I could say it will, but I have no idea.

There needs to be a better system.

Why should I have to “prove” my disability over and over again?

I’m not going to grow a new, working, arm.

It’s frustrating.

But, I’m trying to be patient as “the system” works through my case once again.

Hopefully, I’ll know more within a week.

At the same time, I’m mindful to be grateful.

It is time for Thanksgiving.

My kids are healthy.

We don’t have a perfect life, but we have a good life.

And yes, I am grateful.

One Response to “Pre-Thanksgiving and Insurance Woes”

  1. Mj

    Glad to hear you are grateful despite your insurance woes and the imperfections of life! I often have to remind myself that if I never had any hard times I would not know how to be grateful for the good things. Hope you get the insurance settled and your arm gets the treatment necessary to feel better!

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