Calm before the storm

539AM. Cannot sleep. Team conference today. Everyone is meeting to discuss my path of care - PT, OT, SW, Masseuse, Bill from OV. The adjuster from BD. I'm hoping not all of this conference will be spent addressing ongoing issues with the adjuster. This is supposed to be about my care but there have been so many problems with this adjuster that my care is becoming impacted. Delayed responses to Tx plans or no response at all. Repeated mistakes, odd denials of Tx vs. odd approvals of Tx - no sense to it. Never returning phone calls. Seems to dislike reading reports. No payments received. It would be easy to label this woman incompetent but no one is sure if that is the issue. Is all this delay, this headache indicative of the insurance business or is this delay being orchestrated purposely by the insurance company. So frustrating. Back when I was discharged from Bridgepoint, Holly suggested a tempurpedic mattress would be easier to sleep on and improve circulation while decreasing stiffness. Dr Ahn wrote me a prescription, the Tx plan was sent off and we waited. The obligatory 10 days for BD to respond came and went with no answer. Holly phoned, left messages and e-mails still no answer. Almost 3 weeks later Holly got a hold of the adjuster who stated she had never received the Tx plan. When she checked the fax - lo and behold! - there it was sitting there, along with many other Tx plans for myself. The adjuster never checked the fax.
Eventually appproval was granted. Still no check. Holly called to arrange delivery of the mattress and to set up a bill. Holly called the adjuster, was told she has sent the check to Holly's office. when Holly checked the address the adjuster had, it was wrong. Holly gave the correct address, double checked what had been been noted and waited. Still no payment. The adjuster had sent the check to the wrong address again. The lawyers got involved. TWO MONTHS after I had obtained the RX, I finally got my bed.
I also received a Rx for a recliner, as I could sit on any of the chairs and the couch currently in the living room. Seeing as this was where I would pass most of my day, Holly decided to put in a Tx plan for the chair. We went ahead and bought it, because I had no where comfortable to sit. The response finally came a few months later. Denied because the reason for it was not understood. The adjuster paid for an independent OT to come and assess my need for such a chair. He arrived with no background, no list of injuries, no history of the accident. All he was given was one page from another persons chart. Once he saw my state and read though some of our copies of the reports he agreed completely with the Rx and state he would give approval for the chair. To this day, we have heard nothing.
This whole predicament has me thankful that I have a legal team who advocates for me. I never have to deal with the adjuster. I could not imagine being in the condition I was upon discharge and then having to start chasing the insurance company for benefits. This stressor would have had a serious impact on my mental health, but especially on Erick's as he would have most likely dealt with it when I was too upset. The MBI clinic the nurse clinician told me that insurance was a big issue at this clinic. Some Pt's are discharged with no lawyer, no community support and have to start dealing with the insurance. I cannot imagine what this is like and whenever I get frustrated with my lawyers or care givers I try to remember how lucky I am to have them advocating and caring for me.
With the changes brought in on September 1st, insurance has changed drastically - much has been taken away from consumers. Yet no one would know this unless they pay attention to this area, or they are dependent on the insurance companies. The pay out for non-CAT pt's has been slashed in half. Attendant care, housekeeping and anything involved with the home etc. is now extra. Before, these benefits were not taken from the maximum amount of the policy. not it is being deducted from the total amount given. If the public knew just how much was being taken away from them, I think they would be furious. But because this is accessible only when the worst happens, no one thinks about it or pays attention. So typically human.