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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