Path: utzoo!utgpu!news-server.csri.toronto.edu!cs.utexas.edu!yale!bunker!wtm
From: CREGIER@UPEI.CA (Sharon Cregier)
Newsgroups: misc.handicap
Subject: Insurance companies
Message-ID: <15113@bunker.UUCP>
Date: 24 Oct 90 02:22:10 GMT
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Reply-To: CREGIER@UPEI.CA (S. E. Cregier)
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Index Number: 11236

For those of you struggling with faceless, heartless insurance
companies, you have all my sympathy.   As my family discovered in 8
harrowing weeks this summer (the problem is not yet resolved)

 . The insurance companies do not count you and your problems as
real unless you are institutionalized!  It does not matter if
treating you at home would not only be HEALTHIER (far less risk of
hospital infections) physically and psychologically, but also much
CHEAPER for them

 .  When you think you have psyched out their Game Plan for allowing
treatments or attendants, they change the rules.

Example:  (Our company, a state sponsored MetLife/Blue Cross
plan==Hey, let's name the names of the GUILTY here!) USED to pay
for RNs in the home if the patient were catheterized.  NO MORE and
no way can you know this until you apply for the insurance
payment.  They USED to pay for licensed practical nurses.  NO
MORE.  If a LPN can do the job--and the range of jobs that the
insurance company has determined that an LPN can do increases by
the week, it seems--insurance will NOT pay for LPN homecare.

About the only way you can get the necessary round the clock care
(turning the patient every two hours, hand feeding, bathing,
medication supervision, safety supervision -keeping the patient
from climbing from the bed- changing bedding--all to the tune of
$Three Thousand every FIVE DAYS) is if a restricted narcotic is
ordered for the patient.  No matter that the narcotic makes the
situation WORSE.  No matter that the insurance claimant put $17,300
of his retirement pay at retirement toward purchasing an extended
policy from Blue Cross, who then segued into Met Life just to make
things confusing--to PROVIDE the home coverage needed.  It counted
as nothing.

Is this why MetLife/Blue Cross in our neck of the woods has ONLY a
faceless post box number in Kingston, NY and NO street address so
that one can travel to the main office to plead a case in person?

Is this why the local Blue Cross office conducts claimants to
secure areas which must be locked and unlocked?  Are they afraid of
a bomb-wielding claimant at the end of his--or her--tether from the
gobblydegook and bureaucratese that they feed you all the while
saying: We're here to help you.  (Their favorite mantra.  Don't
EXPECT any help or understandable explanation WHATSOEVER.  Just
hours wasted trying to reach someone on the phone or traveling to
local offices).

Is it any wonder that the health clinic associated with the case
has a room larger than the examining area just to deal with
insurance claims?  That the room is filled with a kafka-esque
ranking of desks and office workers all trying to figure
out--despite hours spent in seminars focusing on just such a
code--if Code 24D-3005/36A will be accepted by the insurance
company?

A talk with the nurses and a talk with the doctor's insurance
claims secretary (she IS on the patient's side!) revealed that
there are NO NO NO NO good insurance companies.  Period.  They ALL
weasel, delay, confuse, confound.

They don't care if there is no one to look after the patient at
home, or if the patient is too ill to be removed to hospital--the
move would have killed the patient, two doctors told us, and the
patient would NOT have received in hospital the high quality of
care which our borrowed funds, new mortgage, and personal
attendance were providing for the patient.

Are things getting worse?  They can only get worse.  Degenerative
disease, thanks to bad diets, pollution, and environment, is now
taking one out every three North Americans.  It is a far greater
threat than AIDS (which, after all, can be stopped in its tracks by
a change in social behavior).  There is no way even the best
performing insurance company is going to be able to cover the
claims.

There are only three ways, as I see it, of insuring against having
to rely on a health insurance company.

1)  The best buffer against outside control by state or being at
the mercy of fickle insurance companies is to have a large family.
A large, cohesive family is a wonderful buffer against state or
other control.  It gave us just enough time and support to hang in
there until the insurance company made a tiny, weeny, paltry
payment which covered two of the 8 weeks illness involved.

2)  Take out a life insurance policy that will cover the funeral
and medical expenses.  It is the only way that losses can assuredly
be recouped without winding up wholly in the poor house.

3)  Be responsible for your OWN health.  Look carefully at
alternative medical care.  From my own personal experience, I have
found macrobiotics to be far superior to anything which the
alleopaths (medical doctors) offer.  The latter are so limited in
outlook it is criminal.  They want to treat the body the way a
mechanic goes after a car.

To those of you struggling with your insurance companies and
thinking of going for a lawyer, the company tactic is to blizzard
the lawyer with so much paperwork that it takes weeks of
concentrated time to absorb it.  They have ways to delay, and
delay, and delay.