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Who's terms??


arogers

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This is truly the most challenging stage in my life. Forget the melt-down, forget the bottom, forget the strokes.....this is it.

 

Yesterday on my way in to see Bill I was called in the Social Worker's office. The announcement was made that accounting was all over her case, and my insurance was impossible to deal with.

 

It seems that although the hospital has a contract with Blue Cross/Blue Shield, the skilled nursing facility (that uses the hospital's name and is part of the "healthcare system") does not have a contract. To further complicate the issue, BC/BS will not give a rate commitment because with out of network facilities they base payments upon what they pay in the surrounding areas at the time the statement is received. So....the result of this conversation is that we are private pay....We pay the published rate and they tell me they want the money upfront. They will provide me a statement, I can file with the insurance company and will receive 60% of the rate they would have paid had they been billed by the facility.

 

I guess I'll be talking to the Board of Pensions today to try to figure something out. I'm not sure how many stroke survivors have the kind of money they are asking laying around in a checking account...I only know this one doesn't.

 

Speech therapy........Bill announced last evening he'd met with the speech therapist and she'd told him he didn't have any problem. Hmmmm...I'm not sure why the two bouts of aspiration induced pneumonia, and two barrium swallows indicated he has a silent aspiration then, and oh, let's not forget the order for nectar thick liquids. When I got home there was a message on the phone from the speech therapist requesting a call to help with his medical history. Why did I think he has a problem???

 

Oh my, I know there is a lesson to be learned in all this...I just know it....I'm not in control? Of course not. Turn it over to my Higher Power, God? I sure am trying to do that - I just wish the nursing facility would understand it's out of my hands!!! Today is another day...I'll take a deep breath, say many prayers and just keep moving forward. It'll be ok.

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Annie:

 

I am so sorry to hear problems yo are going through, I will pray for you t get over this bump in your life fast, and send you ton of virtual hugs.

 

Asha

 

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Me too , Ann, I am sending you virtual hugs and praying that the insurance company etc will see reason.

 

It is hard enough to go through all this as a caregiver without the "caring professionals" doubting your word about your survivor's conditions. When I have made statements about Ray's various conditions I have had the raised eyebrow look, the depreciating smile and "Oh really, do you think so?" l would think I do know more about Ray's condition living with him 24/7, just as you know with Bill, as opposed to someone who has seen him for ten minutes or so.

 

If you just feel you want to SCREAM, go right ahead. :ranting:

 

Sue. :friends:

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Ann,

 

A month out from Don's stroke we ran into the same thing with BC BS not having a contract with the place we really wanted him to be moved to. At the time they wouldn't even let us private pay instead which we were willing to do. The bottom line is you can drive yourself crazy trying to change the system but in the end they get there way.

 

Virtual hugs coming your way, Jean :friends:

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Annie,

 

I'm so sorry you're having to deal with all the cr**p with the insurance company. I've had my share of battles with medical personnel and insurance to the point I told them to discount the bill as though insurance was paying it, then send me a final bill. I had one bill adjusted from over $1,000 to $109 and paid the darn thing rather than continue to fight after 9 months of battle.

 

We currently pay $583/month for Gary's retirement insurance and our medical bills are much less than that per month. I chose to keep him home and do his therapies here as much as possible rather than raise my blood pressure dealing with the medical community and insurance company. We have one outpatient p.t. that he sees 2 times a week and so far no hassles over the past nine months, and he's making progress in that area. It seems others in the past since his being released from rehab were only in it for the money and when I saw that they were billing insurance at $150/hr. and not doing near as much as we were doing at home, I cancelled them.

 

I hope Bill can get the therapies he needs without any more hassles for you as you need to be mentally and physically intact in order to be his main support. :friends:

 

Sarah

 

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Oh my gosh Ann, is it a possibility to find out from your insurance company what skilled nursing facility in your area is considered in-network. If there isn't one, then the insurance company usually pays the network % of reasonable and customary rates.

 

Another resource may be your States insurance commissioner.

 

Make sure you read a copy of your policy - and do not trust the customer service representatives at your insurance company, they may not have the correct information (in the computer) in front of them......

 

Insurance companies can be just down right wicked!

 

Hope it works out for you and Bill.

 

-Karen

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