Ok, Well Like I said yesterday they let me come home on IV's, which I am very happy about :) The thing I am not so happy about is how we got here. Ok here comes the back story.....again......
Just over a year ago, my family and I moved back to Mt from Or for a new job my hubby got. When we moved we elected the COBRA because, of course, I can't be without insurance (ok I can, but that's neither here nor there) My husband had really really great insurance with his last company, and because of this we decided to keep the COBRA, even when he became eligible for benefits with his new company, I mean the coverage was better, and it was less money.... even paying the COBRA costs. I have also been on medicare for a couple years, so I wasn't really ever in danger of being without insurance, but it sure is nice to have double coverage..... not to get into the mess that is medicare part d.....
This year when open enrollment came up again we had to sign up for the plan through Wes's company since the COBRA was set to run out in March. That means that this hospitalization was the first with my new insurance. An insurance that has a $5700 deductible that we have to pay out before they will pay for ANYTHING, including prescriptions.
I knew back in Dec that a hospital stay was in the cards for me, but I had to hold out till Jan so I could kick that deductible out and get coverage for my rx's. Fine, ok, I can spend $5700 easy in the hospital ~lol~ What I was not planning on was the fact that even though I'd been in the hospital for 2 weeks, the insurance had not processed my claim, so it doesn't look like I've met the deductible (in retrospect, I really should have seen this coming). The docs started talking about letting me come home on Mon or Tues of this past week. We were setting things up with home health and such, all was good. So, you can imagine my surprise on the day of my expected release when the home health company called and wanted me to pay upfront for the home IV's!!!! It was "I hadn't met my deductible"...... ok, 2 weeks in the hospital, pretty sure it's more than 5.7K.
Coming up with the money upfront was just not feesable for us, and I let my caseworker and the Dr's know that there was just no way we could pull that off. Everyone was like well that's ok, we'll just keep you in so you can finish up the antibiotics and be ready for surgery. I was bummed that I couldn't come home, but really, I'd rather stay in and get the treatment I need than go home before I'm ready. On Fri afternoon my caseworker came in and said that he'd just heard from the insurance that they would no longer approve my stay at the hospital.... even though all my doctors (Pulmonologists, Endocrin, ENT, Infectious Disease) agreed and told the insurance that I was not well enough to be without antibiotics. the insurance sent it to their "physian review board" who turned out to be a Family Med Dr with no exp with CF.... at least that was my understanding from what my Dr said..... Anyway, besides all the recommendations from Dr's who actually know me and can see me the insurance said no, 2 weeks is all she gets. Now, I was faced with having to choose to stay in the hospital and potentially having to pay for it 100% (if medicare didn't pick it up) and paying upfront for my home IV's. You guys know which one we chose..... but man am I bitter. Really, it just irks me to know that insurance companies get away with this. I feel very fortunate that this is the first time this had ever happened to me. I guess in my own perfect world I was under the assumption that people mattered..... boy was I mistaken. Now not everyone playing in this game is the bad guy. My hospital went to great lengths to try to accomodate my needs with the medicine, even going as far as trying to set me up through their infusion center so the meds could be billed through the hospital. Unfortunately in the end nothing panned out, and we had to bite the bullet and shell out the money..... all I can say now is, Thank God for family, and tax returns ~lol~
This year when open enrollment came up again we had to sign up for the plan through Wes's company since the COBRA was set to run out in March. That means that this hospitalization was the first with my new insurance. An insurance that has a $5700 deductible that we have to pay out before they will pay for ANYTHING, including prescriptions.
I knew back in Dec that a hospital stay was in the cards for me, but I had to hold out till Jan so I could kick that deductible out and get coverage for my rx's. Fine, ok, I can spend $5700 easy in the hospital ~lol~ What I was not planning on was the fact that even though I'd been in the hospital for 2 weeks, the insurance had not processed my claim, so it doesn't look like I've met the deductible (in retrospect, I really should have seen this coming). The docs started talking about letting me come home on Mon or Tues of this past week. We were setting things up with home health and such, all was good. So, you can imagine my surprise on the day of my expected release when the home health company called and wanted me to pay upfront for the home IV's!!!! It was "I hadn't met my deductible"...... ok, 2 weeks in the hospital, pretty sure it's more than 5.7K.
Coming up with the money upfront was just not feesable for us, and I let my caseworker and the Dr's know that there was just no way we could pull that off. Everyone was like well that's ok, we'll just keep you in so you can finish up the antibiotics and be ready for surgery. I was bummed that I couldn't come home, but really, I'd rather stay in and get the treatment I need than go home before I'm ready. On Fri afternoon my caseworker came in and said that he'd just heard from the insurance that they would no longer approve my stay at the hospital.... even though all my doctors (Pulmonologists, Endocrin, ENT, Infectious Disease) agreed and told the insurance that I was not well enough to be without antibiotics. the insurance sent it to their "physian review board" who turned out to be a Family Med Dr with no exp with CF.... at least that was my understanding from what my Dr said..... Anyway, besides all the recommendations from Dr's who actually know me and can see me the insurance said no, 2 weeks is all she gets. Now, I was faced with having to choose to stay in the hospital and potentially having to pay for it 100% (if medicare didn't pick it up) and paying upfront for my home IV's. You guys know which one we chose..... but man am I bitter. Really, it just irks me to know that insurance companies get away with this. I feel very fortunate that this is the first time this had ever happened to me. I guess in my own perfect world I was under the assumption that people mattered..... boy was I mistaken. Now not everyone playing in this game is the bad guy. My hospital went to great lengths to try to accomodate my needs with the medicine, even going as far as trying to set me up through their infusion center so the meds could be billed through the hospital. Unfortunately in the end nothing panned out, and we had to bite the bullet and shell out the money..... all I can say now is, Thank God for family, and tax returns ~lol~
Honey, I am so sorry the insurance company sucks! I can blow them up for you! None the less, I am glad you are home and enjoying a few days a of freedom before the take you back in. I love you!
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