My husband had a hemhorragic stroke almost 6 weeks ago which left him with visual dificiencies. He has trouble reading and isn't able to drive. He was discharged from the hospital almost 4 weeks ago and we have had no success scheduling follow up appointments for therapy since then. Proper therapy is crucial immediately following a stroke to optimize recovery. We have Aeta HMO insurance and all out of network doctors are denied, even when services recommended or required aren't available within our network. Does anyone have any suggestions on how to deal with insurance companies?
Shawkes,
I'm so sorry that your insurance company is causing your husband so much difficulty getting the therapy he badly needs.
I did a search online and found this. Even though it is from another disease...check it out:
Hi Louisa, Thank you so much, these are great suggestions! I appreciate you taking the time to respond!
Good morning shawkes, after my bleed 10 years ago I was left with double vision. Had to wear a patch over my dominant eye for a couple of years until it went away. Good thing our closest university around here is the pirates. I also could not drive for 2 years, I say could not, because my wife wouldn’t let me, if given the chance I would have drove myself home from the hospital after my bleed. I LOVED to drive back then, anywhere, everywhere but as of late I would just as soon not. I don’t know if because it is too much trouble. I walk with two crutches, side affects from bleed or radiation to kill my AVM, not sure, but it’s a lot of work to get in and out of vehicles. I will advise, if you buy a gun rack to put your crutches on inside the vehicle instead of just throwing them in the back of the truck, where they bounce around and get beat all up, expect stares and weird reactions. I was getting out of my truck at the local Walmart the other day and this woman and her 2 kids were also getting out of their vehicle parked a car over. She saw me reaching to gather my crutches off the gun rack, got wide eyed and told the kids, get back in the car, get back in the car. I had to chuckle but it’s sad that people feel that way when somebody reaches for their crutches and somebody else thinks your reaching for a gun to go shoot up the place. Anyways, about the insurance? Don’t get me to start lying, I don’t know a thing about insurance except that it is a big scam and ripoff of the American people. You spend 20 or more years paying into a place, you think exists, we’re not really sure, we just send in our money by mail or computer and the first time you want to report even a small claim, your rates go up and/or they want to drop you. I think I’ll start doing that. Everybody send me your money and when something goes wrong, oops too bad, sorry, we don’t cover that or that does not meet our standards so you will need to find another insurer, good luck, thanks for your money and bye, bye know. But really, I hope you can find the answers you are looking for and I hope your Husband gets back to his old self soon. Good luck and have a blessed day.
Hi Shawkes,
Since I see you're in California, I looked up the office of the ombudsman at the state insurance commissioner. They are supposed to help consumers when they are wrongly denied coverage. They might be able to help. Good luck!
Contact us:
California Department of Insurance
Ombudsman's Office
300 Capitol Mall, Suite 1600
Sacramento, CA 95814
Phone: (916) ■■■■■■■■
Limited English Proficiency (LEP) Phone: (916) ■■■■■■■■
E-mail: ■■■■■■■■■■■■■■■■■■■■■■■■■■
Shawkes, I think Louisa's link below is a really good one. I'm so sorry you have to fight for this. My husband had a hemorrhagic stroke 20 months ago and had double vision for almost a year afterward. His OT recommended some games on his iPad to help with visual tracking. I remember that a game called "Free Flow" seemed to be really helpful. Also, she gave us a "Brock String" to use at home which also helped. I don't know if your husband's vision problem is the same as my husband's, but I can tell you that six weeks out I didn't think he'd be able to read again (or walk or talk), but I can tell you that the brain is amazing and it takes time to heal. Today, he can read, he can walk, he can drive, he can speak well enough to be easily understood and has a great life ahead of him. Hang in there, and fight the fight with the insurance company. Look for an advocate in your area to help you if you can. Here's the info on the Brock String - it's simple, you can make it yourself and he can do it at home. Good luck!! http://www.thevisiontherapycenter.com/discovering-vision-therapy/bid/94890/How-the-Brock-String-is-Used-In-Vision-Therapy
Thanks, Pam
Go after the insurance companies....great that you sent her the contact info, Julie!
I have a family member and a friend who hit a brick wall with their insurance company refusing to accept certain treatments and/or doctors. They fought back by appealing and just persistently calling and writing the company -- they eventually got to someone in the hierarchy that said it would be OK. And certainly during this process of rejection, you are creating a good case file as you work through the layers of decision-makers. What type of therapy are you seeking? PT, OT, Speech? I know this it hard with an HMO, but you should schedule an appointment for your husband to see a primary care doctor there, and then point blank ask him or her how one expects you to get the services your husband needs to fully recover of there company won't cover it? Have you looked carefully through the HMO's benefits document? What does it say for such services? And what kind of HMO plan would not provide therapy services to patients? Most HMOs, if they don't have an in-house PT, OT, speech therapist (and most don't) will allow you to go to a private one or out of network (the HMO save money by not maintaining such practices in-house). Please let us know how it goes. I find this very upsetting. Take care! Sharon Davis
I know this website has to do mostly with birthmarks…but the info they give regarding appeals applies to all…you need to read thru it.
I do agree with Sharon…my case was turned over to a case manager to try to control what services, tests etc…will be approved by BCBS mine is a PPO…they want you to give up…the insurance companies don’t want you to have the patience to pursue your case…keep at it…don’t take no for an answer…best of luck…you and your husband deserve the best of care!
My insurance co. denied to pay for my AVM / heart attack surgery because I didn’t call to get pre-approved. Fact is, I was unconscious when I arrived at the hospital and did not know I had been in an ambulance! I found out that almost every hospital has a “patient advocate”. It took two hospitals and two advocates before I was approved. My advocates had to prove “medical necessity”. It also took several months before being notified by my ins. that all would be covered. Please try to reach the advocate and state your case to him or her. Also have a pen and paper ready to record the date and time you called and the name of the person with whom you are speaking. Good luck. I know how much extra stress this is putting on your situation. Stay strong. I hope the very best for you and your husband. Leevale
Thank you so much! I really appreciate all the great advise, suggestions and encouragement!
Hi Sharon,
Thank you so much! My husband needs vision therapy, we're told he needs a neuro ophthalmologis. Our insurce company claims that the doctor our GP requested is a tertiary level provider and their review does not support the need for tertiary care at this time as he doesn't require special testing or care that isn't available withing our healthcare network of on tertiary providers. Twice we were instead refered to same group who told us they are unable to provide the therapy we need.
We've also run into a wall with cardiology. Upon discharge at UCLA Medical Center we left with a pland of recommended procedures to reduce the risk of a second stroke. Now that we've been redirected to a local cardiologist within our plan these recommendations are disregarded as they don't offer these procedures. The insurance denial letter used the exact same tertiary care reason and upon their review determined my husband doesn't need this type of specialized treatment.
We are now starting the process of writing appeal letters.
Thanks again for the suggestions and recommendations. It gives us hope to hear others have had success in the end.
Sandra
My heart goes out to you and your husband. My AVM rupture affected my vision and I saw a neuro ophthalmologist. It is hard to find a good one. I would be even more worried about the lack of proper cardiology treatment. My sister fought her insurance company with all she had because she wanted to try embolization of uterine fibroid tumors, instead of having a hysterectomy. She learned that the rejection letters were not actually prepared by anyone who had any medical background. In fact, some of these letters generated had misspellings and typos. What qualifications do these folks have to assume your husband should not receive this treatment? It is worth asking. My sister figured it was some kind of form letter these people just filled in blanks. They don't care if the ultimate outcome is that the person has to go through a more expensive procedure (surgery v. embolization) or that good followup care may prevent further hospitalization. Buy a notebook, and keep detailed notes of every phone call you make, take down names, and keep a file of every paper your insurance company sends you, plus copies of what you send them. See if the head doc who treated your husband can include give you a letter. If you can change insurance companies, I would do so. At least it is illegal now to deny or increase the price of health insurance to someone with a preexisting condition.
Good luck and hang in there!
Shawkes - Who is your insurance company? I am in the LA area, but perhaps I can do a post in our LA group regarding the company to see if anybody has dealt with them before. I have also found that if a doctor of yours is willing to get on the phone with the insurance company (mine did and spoke to a medical professional at the insurance co.), the procedure was approved. Btw, don't give up, whatever you do. Sometimes out of network is at 50% copay. If you have found a doctor you need to go to, but isn't approved, maybe they can help to get their visits approved, or work out a payment plan (maybe at a discount with them). Best of luck.
bug the hell out of them