My Right Foot: No Means No

I am home from the hospital now. It’s really wonderful to be in a more serene environment for recovery. I am so happy to be finished with the chaos and hustle bustle of dealing with doctors, nurses and other hospital staff.

But now the hard part begins. No, I’m not talking about the healing and physical therapy part, but dealing with my insurance company. I got a whiff of it today.

A woman from Blue Cross Blue Shield called and identified herself as my “case manager”. I was pleasantly surprised that someone was checking up on me and trying to help me out. Since my surgery I have had a lot of questions, but I just didn’t have the energy to initiate the call myself. My two big concerns right now: help at home and transportation when I return to work. These are important, but I didn’t focus on them during my pre-surgery research process. At that time, I was more concerned about paying huge physician and hospital fees and how much BCBS would cover.

So I asked the case manager—a pleasant lady—about getting a home health aid. I explained that my husband and adult children are working and I need help at home.

“Is it a medical necessity?” she asked.
“Yes, I said. “I am on crutches and the doctor says I need to be in bed 80% of the day.”
“No, that’s not considered a medical necessity.”
“How can that not be?”
With no emotion, she said “It’s not covered. That’s excluded.”
“What about transportation to and from work?”
“Is that a medical necessity?”
“Yes”, I said again. “I live in New York, work in New Jersey and surgery was on my right foot, so I won’t be able to drive for a few months.”
“No, that’s not covered.” Adding to rejection, “I have never heard of transportation costs being reimbursed!”

I have resources to get through this. But what do other people do? We all think of the big hospital bills we need to pay, but how do all those many out-of-pocket bills get paid? They may seem insignificant, but they certainly add up. I am bracing myself for the “real” bills to show up in my mailbox and many more conversations with my friendly case manager.

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  1. Sandra says:

    Glad to hear you are feeling better. Wait until you are older and on Medicare, you may get this comment someday, “well if you were in your 20’s we would do an MRI to see why you are still having problems with your hand, but since your aren’t we won’t”.

  2. Carol Cliff says:

    Bless you Susie! Hope to see some stories on NBR about medical issues like you are facing. And as a former “professional lady” (VP computer programming) who wore high heeled shoes before I had to quit working in my 40s because of medical problems, let me assure you that there is indeed life after high heels :-) In fact I now consider wearing high heeled shoes about the stupidest thing I ever did – though at the time I was doing it, of course I didn’t think so.

  3. Marg Gillett says:

    hi susie ,
    Good luck with your recovery. I think the insurance companies should talk to the nurses and therapist about what is required for quick recovery ie home help and travel assistance. I am a therapist and cannot wait for the google driver-less car – an affordable mobility for the temporary and permanent disabled let the the school run brig it on

  4. Shirlley Shinder says:

    Wishing you speedy recovery. Glad you are exposing Health Care red tape and silly rules. Have watched NBR since 1983 and manage my own portfolio. Get back on air soon!

  5. Leland Bullock says:

    Get well soon Susi. I was wondering where you were. Thought perhaps at a beach on some sunny island. Been watching NBR since 1989. My day is not complete without your summary of market and business news. Fast and upbeat. You do a great job. Thanks for keeping us all informed.

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