My posting has been rather sporatic, and I'm sorry for that. I have so many ideas for posts go through my head, but it seems like so much effort... am I growing older? Or is it my musings seem so ordinary? I don't know, but I notice many of my fellow bloggers have been much quieter, recently. I think it might be we are spending more time LIVING life, instead of WRITING about it! But, I am going to try to catch up on a few things. I keep this blog as a family diary, and there are photos and things I need to add.
The Oklahoma City Greek Festival has always been a favorite event, and this year was no different. Of course it is not quite up to the par of Detroit's Greek Town, but it does make a satisfactory substitute. :)
At the Greek festival there are all kinds of wonderful delicacies. You can get a full Greek dinner with the stuffed grape leaves and a whole bunch of dishes I can't pronounce, let alone spell! But we always go to the "a la carte" line, because that's where we get the gyros and spinach pie. Oh, and the Greek Coffee!!!
I took this salad with a piece of cheese pie "to go" so I could have it for lunch at work the next day. It made a plain old work day something to really look forward to!
... and the pièce de résistance! How do you say that in Greek? BAKLAVA!!!
We had Shelby's portrait drawn by this artist when she was about 4 years old. I will post it later if I can find it.
Yes, we had to take a cheesy face-in-the-hole photo. We are just a couple of big kids!
The pitcher was up to bat. Accustomed to only pitching relief, this was the very first time he had pitched an entire game and now it was his turn at the plate. His team was behind by one run. No pressure, right?
The windup... the pitch...
The young player flashed into bunt position. The bunt was perfectly executed, the ball landed just a few feet into fair territory. The runner sprinted from third while the shortstop scooped up the ball and fired it to the catcher at home plate. SAFE!!
The runner from second base made it safely to third, and then took off like a shot when the catcher bulleted the ball to the first baseman. SAFE AT FIRST as the winning run crossed the plate!
The team dumped the Gatorade jug on their pitcher who had just bunted in the winning runs. Even if he never does anything else in baseball, he will have the memory of this game forever.
Every kid needs to experience having the Gatorade dumped on him at least once in his life.
There is no way that I am claiming any responsibility for this one. Nuh-uh. Not me!
It all started about three weeks ago when Shelby was home from college for a weekend visit. She mentioned that her meal plan funds were running low, so I bought her about 3 weeks’ worth of meat for her to take back with her, nice mom that I am. Unbeknownst to me, Shelby packed the meat in the little cooler that I use to keep ice in my clinic. Since I have no fridge there due to the remodel, I have simply been filling it at home every morning and taking it to work with me. It wasn’t until after she left that I discovered it was missing.
When I asked her about it, she was suitably contrite, so I wasn’t too aggravated since she didn’t realize I had transformed it from a “family” cooler into a “work” cooler. Besides, I always have a Plan B.
Plan B in this case has been keeping the ice in a large zip-lock bag inside the ancient microwave that lives in the clinic. I say that the poor old thing “lives” there because it is not mine, and nobody seems to know whose it is. It possibly belongs to a Ghost of Teacher Past, since it is one of the earliest models made in the mid-1970s. It is very insulated inside, and keeps my ice frozen all day long.
Until one of my coworker friends tried to heat up her coffee and pushed the bag to the back of the oven.
Until I finished it off by heating up my lunch, believing somebody had taken the bag out. I realized what had happened when I reached in and my lunch was still frozen… but there was a big puddle of water on the bottom of the microwave.
It's not my fault it happened; I couldn’t have put up a sign about the ice, no way!
My dad was the worlds biggest joker! I think this photo of him and one of his best friends taken sometime in the 1940s makes a GREAT April Fool photo!
These two had a great time traveling to New York City to try to break into the recording industry, but I guess I'm glad my dad never made it very far in show biz, because he returned to Michigan, married my mom, and the rest is history!
I received a call from John last night while he was on the bus returning from one of his baseball games, to let us know he was on his way home. In the background, there was a bunch of yelling and horseplay, a lot of that "male bonding" type noise.
A midst the noise, somebody called out, "Hey John! Who ya talking to?"
"It's my mom."
"Your mom? Your mom? Hey, hey John's mom, John had two strikeouts tonight!!"
Then in a chorus they all began shouting: "John! John! John! John! Mom! Mom! Mom! Mom! Mom!"
I stood there frozen and furious. How could they all be so mean?
It was too loud to hear, so John said he would talk to me when he got home. I waited with tears in my eyes, not knowing what I could say about the taunts. It made my heart hurt for him, since I know how hard he has been working at baseball practice.
A few minutes later, he called back to say he was going out to eat with the team. I asked him if he just wanted to come home instead. He sounded puzzled.
"Well, after all the teasing the guys were doing about your two strikeouts, I am surprised you want to go."
He paused, then started laughing. "Mom, I struck out two batters! They weren't teasing, they were happy for me!!"
Turns out, he was a relief pitcher, and pitched the last inning!
... his youngest son who was only seven back then, lit the fire today. I notice he needs a shave. He is seventeen.
Ten years later...
... we stand together as a family and remember. The bad memories are burning away. We keep the good memories. Always.
It really helped to write my posts of the past few days. I hope our story will reach the ears of those who can help change things. Please share it, if it moves you to do so. But now that I have put it into words, I can put it out of my thoughts. That in itself gives me peace of mind.
All the college money I had been saving for the kids was wiped out. I had to cash in the savings bonds I had saved for all three of them, in order to pay bills the insurance wouldn't cover. I had to pay these bills, or the doctors would refuse to see us, plus we wouldn't be able to order needed medical supplies.
Andy's former coworkers brought us a carload of groceries and paper goods. We were overwhelmed with their generosity, but my oldest son felt ashamed. We had never needed to accept charity before. I told him that it was their blessing to give to us, and we needed to not be so prideful as to spoil their blessing. It did feel weird to be in that position, though.
It was obvious that we were sinking fast. Even with the kindness of those coworkers and our church, family, and friends, it wasn't going to be enough; soon we would have to decide between making our house payment and utilities, or paying for the medical expenses. I decided to heed my friends' advice and take my case to the State Insurance Commission to see if they could light a fire under the tail of the insurance company. In order to do that, I had to take a day off from work....!! (Expletive deleted!)
I was afraid that the people at the Insurance Commission would be as cold and rude as some of the people at the insurance company and the collection agencies, so I took my best friend with me for moral support. However, the lady at the agency was very sweet and sympathetic. The only problem was, she could do nothing to help me.
"If you had a traditional health plan or an HMO I could help you," she said.
I asked, "Aren't an HMO and an EPO the same thing?"
"They are very similar, but EPO means the insurance is employee owned, so they set their own rules, for the most part."
She jotted down a few notes for me, explaining that there was a small chance that I might be able to get some help because of something called the ERISA act, but I would have to take it up with the Federal Department of Labor, and it would require an enormous amount of documentation.
She sighed and said, "I wish I could guarantee that this will work. I know this is a lot for you to do with so much on your plate already."
It was a good thing that my friend was driving; I never would have made it home through all my tears and as hard as I was shaking.
Long story short, I did begin the process with the Department of Labor, but soon after that Andy's condition deteriorated and he was hospitalized for several months. About the same time, my new insurance plan through the school plus his Medicare Disability kicked in. Over the next few months my former insurance company began to pick up the overdue bills, but there were some that were missed. I never did get reimbursed for any out-of-pocket expenses that I had paid, because that also would have taken considerable paperwork, and by then Andy was so critical the only thing I could think about was the probability I was going to lose him. Oh, that and the fact that I was still taking care of my kids, working full time, and trying to maintain our home.
If you missed my earlier posts, the reason I took on a different job in the middle of all this is Andy was too sick to watch the kids anymore while I was at work, so I needed a different position so I could work during the same hours they were in school. The new job had great hours, but quite a pay cut came with it. Under the new health care rules of 2012, he would be insured as soon as I started my new employment because insurance companies no longer can turn a client down for pre-existing conditions. If it were that way ten years ago, I never would have had to mess around with Cobra.
The hours and hours I spent on all the insurance red tape cheated us both out of much of our last time together...
... and that was undoubtedly the most expensive toll of all.
I have to smile, while sorting through the box with all these papers, I found this:
I must have been planning on using coupons to offset the $26,000 bill in the next photo. Despite my best efforts, Andy's medical bills were piling up unpaid.
As time went on, collection efforts became more serious. For instance, the State of Oklahoma gave us the choice of paying a bill in full, or signing over part of our tax return.
They did generously include a form for Andy to sign, but I put it aside when Andy had to be rushed to ICU and then I forgot about it.
I was still receiving a huge amount of denials, despite paying almost half of my monthly salary to cover the Cobra insurance. I was advised to talk to the State Insurance Commission. Surely they could help me! Right???
It wasn't enough that I was taking care of a house and my kids, spending time with my critically sick spouse, and working at the school 5 days a week. I had another full-time job taking care of insurance paperwork!
The insurance company instructed me to send certified letters to every doctor, lab, radiology company, pharmacy, equipment company, ambulance, etc. with copies of the updated insurance cards that finally arrived in my mailbox. As you can see, it took a bit of time, energy and money, but I did it.
The denial letters slowed down a bit after I sent out the updated information, but they never stopped completely, even after Andy died. I continued to contact the insurance company, and tried to pay the bills or make arrangements, but some slipped through the cracks. One of the years after he died, I was garnished for an ambulance bill at Christmas time. Nice, huh?
The bottom of this post has the 4 pages of the timeline mentioned in yesterday's entry. For the sake of brevity, I am posting the highlight of the timeline seperately.
Setting the scene: Andy was discharged from the hospital 5 days earlier. I had been attempting to get his antibiotics filled at the local pharmacy, but the insurance was denying payment. The medications were over $400.00, and after all the out-of-pocket expenses I had already covered, I didn't have the money to purchase the medicine. This story actually is hysterical in a macabre sort of way. At the time, however, I wasn't laughing, I was sobbing and pulling my hair out!!! Read on...
Spent entire day on telephone attempting to untangle this mess. I spoke to Kim 188-446-ext 3819 (case manager). She says she does not have anything to do with pharmacy claims, she told me to call Health Risk Management, where I spoke to Lisa at 1-800-255-5541.
She told me to call Express Scripts at 1-800-234-4879, where I was told to call the Cobra Connection at 1-800-733-9110, where they told me to call the eligibility department at 1-800-357-9597, where they told me I needed to call Express Scripts (again) where I spoke to Samantha, who told me she didn’t know how to help me, but transferred me to ext. 59105 where I spoke to Rosie at the Michigan Call Center.
Rosie finally was able to find record of my payment to Cobra, and told me the reason why the prescriptions were being denied was because the ID# was now supposed to be my husband’s Social Security # rather than mine. I had not been informed of this before. (In fact, the letter I had received from Cobra had said that I should continue to use my previous ID cards!)
I returned to pharmacy, instructed the pharmacist to use my spouse’s SS#. Insurance was still denied. I ended up obtaining the prescriptions without the help of the EPO."
I didn’t mention in my letter to Nancy exactly how I obtained the medicine because I wanted to protect the pharmacist… he had been working with me on this since Andy had been released from the hospital 6 days earlier. He took pity on me because by this time I was bawling my eyes out and Andy desperately needed the antibiotics… so that dear pharmacist gave me the antibiotics at my former co-pay rate and said, “This is ridiculous. They can straighten this out after your husband gets started on his medicine.”
If you want more comedy, here is the rest of this particular saga. Or skip it, that's okay, it's pretty much just more from the same circus. Have I mentioned how much I hate insurance companies???
How in the world can I put this out there so it makes some kind of sense to others? It doesn't even make sense to me! After all these years it still is very difficult to figure out the order and organization of that pile of paperwork. The dates blend together, there are mountains of different forms, and mountains of requests for further info. It would be an impossible task to show the magnitude of the issue without showing each individual form, and I won't do that to you! How boring would that be??? :)
I guess this letter would be a good beginning. I wrote this to my director of Human Resources during the early days of Andy's terminal illness. Can you imagine? This was just the beginning! Sorry, I can't bring myself to re-type all of this, so I did a photo scan of each section... click to enlarge...
I had left my full-time position at the hospital to work for the school, because Andy had become too sick to work and to care for John and Shelby while I worked. His insurance was canceled after his medical retirement, but he had to wait 6 months to qualify for Medicare. I took the Cobra insurance through the hospital because of his pre-existing condition, and it would take several months before my new insurance through the school would cover him.
Yes, they really asked if I had family members or neighbors to take care of his medical needs!!
What Nancy and Cindy advised me to do was make up a timeline of events so they could look into why all the bills were continuing to be denied. My head was already spinning, and now I had to try to piece together everything! My best friend came over that evening to help me put together all the paperwork and try to construct a timeline. It took us over 8 hours, working together.
Tomorrow I will post that timeline. Until then, thanks for listening.
The ten year anniversary of Andy's death is rapidly approaching. Over these years I have written many items regarding grief, recalled many happy and bittersweet memories, and poured out my emotions in general. One thing I haven't told is the awful story of the mountains of medical bills we dealt with, and how the walls kept closing in as I wrestled with the insurance company to make sure Andy received the benefits that my insurance was expected to cover; the medicines and treatments that were keeping him alive.
In addition to the anguish and fear we both felt as Andy slowly headed toward the light, I was also dealing with this:
These photos show the reason for my red-hot hatred of the insurance industry. It would not have upset me if these were statements of bills paid. No, that's not how it worked then, and that's not how it works today. These are piles and piles of denial letters and subsequent correspondence. These represent the bald-faced fact of health insurance companies...
They are not here to help us stay healthy or regain our health.
They are here to make a profit. Period.
At the time, I told my family and friends, "I am seeing the future of medical care and insurance, and it isn't pretty, folks."
We were a couple of the earliest baby-boomers to see what's in store for us if drastic changes aren't made. President Obama's new health care plan is a baby step in the right direction, but it doesn't go far enough. To prevent this from happening in YOUR future, we need a single payer system. For a system to make any family with a critically ill loved one have to go through this paperwork nightmare, to keep the patient receiving their treatments, is unconscionable.
During the next few days I will be posting a few of the insurance "highlights" that we went through. As recently as two years ago I wouldn't have been able to consider doing this. Even still, thumbing through this stuff makes the panic rise in my chest, and like invisible hands are wrapped around my throat, slowly suffocating me.
Maybe my story will help someone else.
I know it will help me to tell it.
At the end, I am going to mark the tenth anniversary of Andy's death with a lovely bonfire. I wish it were that easy to burn up all the bad memories.
Our beloved dog Tom Girl crossed the Rainbow Bridge today. We adopted her in 1999, and was Andy's assist dog, (after Sheba) until his death. I'm sure he was there to meet her at the other side of the bridge, although she might not recognize him at first without his wheelchair! :)
Tommie was not sick, or at least she gave no indication. At age 13, it's normal for a dog to have a little stiffness, but she still enjoyed playing in the backyard with Marvin and Jack Daniels.
This morning, Arthur found her in her bed when he went to let the dogs out. She looked like she was asleep, all curled up in a comfy position, with her eyes closed. At least there is no indication she suffered at all.
She was half Newfoundland, and I called her my "Big Bear Dog." I often joked that I "got Tommie her very own Dalmatian," because I hated leaving her home alone when the kids and I were at school. So Tommie really is partially responsible for Marvin coming to live with us.
Later, when Arthur and I got married, she had a new friend to be there during the day. Art took over the feeding and care of the big dogs, and she became pretty attached to him.