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Polytrauma and TBI Survivor - Never Give up HOPE

A day, much like any other started with the morning being full of hope, excitement, and a sense of pending accomplishment. We could never know that in a matter of moment[...] read more

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Beat but Not Beaten - MI No-Fault Reform Needed

MEDICAL RANT - LENGTHY POST:

5 Important Questions to Ask yourself.....

1.Reform Needed with MI No-Fault Protection? Yes!

2.No-Fault gotten rid of? A Resounding NO!

3.Option to Opt-Out of No-Fault with Vehicle Insurance Policies? Absolutely Not! The majority of people do not even know what this policy is supposed to provide. You cannot predict getting into a wreck and the injuries you may or may not have.

4.Benefits of Consumers/Patients Reduced or Removed? NO!

5.Enforcement policies compelling insurance companies to follow the law and adhere to established deadlines without stalling a patients care? Yes! (this cannot happen fast enough)

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Now....how this all applies to me and my RANT?

The wreck....the gift that keeps on giving *sarcasm* 3.5 years later....I have been diagnosed with Left ear hearing loss from 2 different audiologists and one ENT. Their recommendation: Hearing Aid.

So I bit the bullet and tried on various hearing aids to see what would work for my particular ear/issues/etc...this was NOT an easy appointment for me....it was just one more thing, ya know???

At any rate...MI No-Fault should cover the hearing aid as the hearing loss is documented as a result of my traumatic brain injury and polytrauma all from the wreck. It is documented as a permanent loss as well. 
I submitted the quotes to Insurance....I currently am being ignored as are many of my providers. Even my medical case manager is being ignored.

The famous words of Insurance Companies "we don't pre-authorize" and "we won't pay for it". This is something they have said to the providers and to me about literally aboout every surgery and every medical therapy I have been prescribed and or completed. The reality is they don't pre-authorize.  The law states a patient gets care for auto related injuries, submits the bill or the provider submits the bill, insurance has to pay it within 30 days of receiving the bill. However they pick and choose which providers to pay or not pay and even play with the amounts they pay these providers.  They have paid the majority of hospital type visits for me, but not all.  They have not paid ANY reimbursements for out of pocket medical costs/appointments, and their stalling continues.

Some appointments (including all our trips to Minnesota to see the Trauma surgeon 7 times in 2016 with 3 reconstructive surgeries and 1 time in 2017 thus far) I have had to pay out of pocket for all travel related expenses/toll booths/plane or train tickes/gas to drive, hotel stay, food etc and Insurance is supposed to reimburse us within 30 days. HASN'T HAPPENED!!! Do you realize that No-Fault is a benefit and never requires pre-authorization anyway. We were using my benefit check (which ended January 2014 - has a 3 year limit) from Wage Loss to get by.  We have put out more than $10,000 (out of pocket) just for the trips to Minnesota.......we submitted bills and receipts....promises given with no follow through.  Still no reimbursement, in case you missed that.  We didn't have that money to spend for anything other than bills and survival.  Faced with impossible choices as the trips HAD to happen to help me rehabilitate without more delayed treatments due to the "insurance round robin" of denial, stall tactics, and lies.

My Neuroendocrinologist we paid $600 for out of pocket last Summer (and I still owe $175.00 for another appt and cannot get more appointments until paid follow up appointments are imperative)....that 30 day reimbursement from insurance which is supposed to be paid to us would have paid for future appointments .....yeah... THAT HAS NOT HAPPENED EITHER.

The hearing aid with Bluetooth capability so I can use an app on my phone to adjust volume, squelch, etc....$3,200.00 and the doctor's office won't bill...they want cash ( I understand but really who has the kind of cash just sitting around on top of everything else).....UGH UGH UGH. So I go without it. This affects obviously my hearing, but my conversations/speech as well and can cause some embarrassing moments.

The insurance company even stopped paying for all prescriptions once I lawyered up.  They were already denying several before legally involved.  So I am not sure what their point is???? Maybe if they ignore enough NO-Fault recipients they will just give up or die????

SO when we struggle to buy groceries, pay our utilities, make payment arrangements that we end up not being able to keep....when we struggle to buy clothes for the kids like all parents do, special dietary food for our child with special needs, or even basic things like you know.....toiletries...toilet paper.....it catapaults the whole family into this financial starvation mode that is a never ending vicious circle with our money being held captive....because they can.

The laws on the books are there to protect the consumer and remove stress from the rehabilitating patient and their family. No-Fault is in place to avoid catastrophic financial issues like this. However, there are no laws on the books to keep insurance companies accountable for following the laws. So they can play with people's lives, emotions, livelihood, and finances with no accountability They can draw it out for weeks, or months, or years.

So if I seem anti-social or not interested in doing things away from home as a family.....that is only partially true.  If I don't take my kids to social outings that require money (costs to get there too - gas is not free), family vacations (we don't even know what these are like - never had one lol), Summer travel trips, and all those other things that we have loved doing with our kids in the past (and never taken for granted).....this is a huge part of why we say no to you, to them, to ourselves.

It's not that we are irresponsible, lazy, or don't know how to manage our money....it's because one parent has lost employment and hasn't been able to work since 2014 (me), the other parent has been my primary medical caregiver for the majority of that time (my husband) and we are both attempting to keep things as structured as possible for the sake of the kids....which is beautiful in theory but not reality.  My husband works, cares for me, cares for our whole family really.  I am still recovering.  Finding outlets like this to hopefully educate others and find value in my life (aside from being very grateful for my life) and much smaller world.

My heart goes out to those who are paralyzed, on ventilators, or having to struggle in similar ways with similar injuries as me (polytrauma and traumatic brain injury). I can only imagine how devastating that would be/has been..... what would happen if unable to get their much needed supplies and Attendant Care.   My heart also goes out to those without a No-Fault system in their State.  A catastrophic wreck for some leaves them temporarily disabled, permanently disabled or is a death sentence. Regardless of the level of trauma....one things is for sure....it is life changing. 

Health care is a right, not a privilege. The No-Fault system is a BENEFIT....not something requiring pre-authorization or manipulative tactics. Holding someone's money to manipulate their medical care, their ability to sustain life, and blackmail them is illegal for us as Jane and John Doe public, why not the insurance companies? (rhetorical). I hope something is resolved with this soon.

Though I have been beaten over and over through all of this.  Whether the metal from the wreck, the sudden stop of the asphalt against my body, delayed treatment or injuries not addressed until out of control, the assault from my own body trying to survive it all, the raping of our family wallet, the changes that make every precious day almost impossible too endure, the insurance company who holds our financial survival in their perpetual hands with our money tied up with their strings and moved around like puppets in some horror show.

Well to all of this I say.....Yes I have been beat - but I am not beaten!

I choose Life!  Release my money and let me provide for my family with MY MONEY.  Stop making my rehabilitation efforts harder or not possible.

Okay.....I feel better now...RANT OVER...

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