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Thursday, March 17, 2011

As Predicted, They Try to Take My Benefits

Late addendum to this one:  first, the provider is now actually the Reed Group, ECM is an intermediary.)  Second, you never know who might be reading your blog.  Third, it's been communicated to me that this is happening because of Reed's take-over of Aetna's accounts, which I can understand-but it the end it's me who gets to go through the exam because of Aetna's lack of documentation.  Anyway, this is a gripe, but a gripe only and I'm going to the eval.

My docs have said I am an extremely paranoid person.  Personally, it's not paranoia if everyone really is constantly out to screw you.

Recently Intel's long-term benefits provider has changed from Aetna, a name I at least know, to some new company called "ECM."  As of a certified letter that arrived on Friday the 11th I am being scheduled for an all day (really, ALL DAY) invasive and intensive physical therapy review next week to determine if I'm really actually sick.

This review is being scheduled despite the following:
1) I have had many other independent reviews.
2)  I flew through an independent Medicare review of my disability status, and the gov't folks have no issues.  In fact, the doc at the Medicare provider said to call her if anyone ever tried to deny my benefits.
3)  My medical charts at my doctor's offices are six inches thick.  Workplace safety standards require that it be carried by two physician's assistants.
4)  The act of doing the review itself could very easily hospitalize me, which we made very clear to representatives of this insurance company.  They claim to have my primary care physician's buy-in on this testing, something I doubt very much and intend to check on today.

I'm not sure if I've done a good enough job of indicating how sick I am in these pages, and a some people have given me negative vibe over the perceived "whining"-- let me try again:

  1. I am 44 years old.  Up until the age of 40 I was very used to working 12-16 hour days out of sheer love for my job and the people around me.  I was on company travel 80% of the time for a lot of years.  I made six figures.   I had life insurance, if I had died on company travel the payout to my family would have been amazing.  I have no life insurance now.  My kids don't have health insurance.  Neither does my wife.  
  2. Now, I am poor(er) and have lost my house, not due to the market meltdown, but because I got sick.  The market meltdown was just very well timed for us.  Yup, we sold short.  I'm a credit criminal.   It was a close thing to even find a place to rent after losing our home.  My family has landed in isolation, miles away from our nearest relatives.  
  3. I never, ever, EVER leave my house.  My day starts at 5:00am with a wakeup to unbelievable pain, and ends the same way at midnight or so.  I spend all the time in between writhing, passing out, and spasming-trapped an uncomfortable electric wheelchair that is broken most of the time.  There was a time when I could hobble, and there was a time when I used a cane, and there was a time when my disease flare ups were spaced at least a couple of hours apart.  Not anymore.
  4. Oh, and the only place we non-persons could find to rent is a two story, which does not work for me in any way at all.  I make my way up and down the stairs once a day, by grabbing the banister and pulling while my wife pushes on my butt.  I have no idea what she's going to do if I fall.  So far when my legs give out I have lurched to the side and grabbed the rail, but I've actually started blacking out, so things are going to be interesting.
  5. I own twelve or so electric guitars and about ten tons of equipment, which to me are the trophies of a life well spent.  I haven't touched them in a long time.  It hurts to play.  Bad.  
  6. Without fail, going somewhere, anywhere, and doing anything at all will put me on my back in bed for several days, while I sleep for 20 hours a day or so.  
  7. My immune system is destroyed.  If anyone is sick, I will catch it, it will be horrible, and it may put me in the hospital again.
  8. Stress makes me more sick.

So, with that said, it pleases me to no end to suffer and twitch for the amusement of the new review board put together by my insurance provider to kick sick people to the curb.  I will make one thing very, very clear in writing, here:  If I end up hospitalized, sick, or suffering a setback from this review next week I WILL LITIGATE.  If this insurance company attempts to cut my benefits, I will litigate.  If I am mistreated in the exam by surly, unprofessional doctors or their assistants,  it will get ugly.  I am wondering if it is not smarter for me to find a lawyer immediately and properly define the relationship I have with this insurance provider, but lawyers want money too (or perhaps more.)  The bottom line is that I represent a whole lot of money that they don't want to pay, and it makes a lot more sense for them if I'm dead.  I'm surprised Aetna did not hire assassins-over the long term this is a lot of money.

I am damn tired of being accused of not being sick.   Be absolutely assured that the last thing I ever wanted to do in my life is rely on the bureaucratic, pragmatic evil of the insurance industry for my family's long term security.  This is the boat I'm in, and I don't have any choice but to row.

1 comment:

  1. Karl, please send me an email with the date your all day event is scheduled.