Just When You Think


You have a handle on everything in your life. you never really get to catch a break. Life throws curve balls at you — mostly to test your ability against the odds. This is a test in my faith in God; this is a test in my attitude and how I handle what is about to come. Perseverance

I am blessed that my prescription drug coverage came back as favorable – thanks to the U of M medical staff and my advocate working double time. However; one thing is going right which means.. that something else has to come about it. To level it out…

Many of you know – I’ve been battling medical appeals with Medicare for over a year. I have nine appeals that are currently in the reconsideration phase; which means the case worker will analyze all of the information and make a decision. For the last 9 months’ the appeals have returned “UNFAVORABLE” which ultimately means the insurance will not cover the costs of the medical treatments. The reason – which is outlined in these blanket responses from Medicare; is that my diagnosis does not meet the requirements of a disabled individual. No matter how many times that I send letters of reference from the doctor, photos of my body deformity, lists of medications, lists of surgeries and treatments — it will never be enough for them. The thought of this process; that I’ve been going thru… makes me feel like I am going INSANE. I am trying to stay level headed but I just cant wrap around my head why our medical system is so messed up. Each time; I think I find a caseworker that is listening to me ;; I’m switched to another person that I have to re-explain the entire situation.

Medical Advocate

This year, I found an advocate after months of pounding on doors trying to get someone to listen to me! My medical advocate calls me monthly – and a few days after every appointment to check on me. I absolutely LOVE that; I received a call today actually. But let’s back up…There’s something missing from this story, the peak.

First – Medicare called me. They have been calling every other day for the last 2 weeks; I’ve left countless messages asking on the status of my appeals but no one seems to have an answer. Medicare contacted me in regards to a letter that I wrote about my disease. I poured my heart and soul into the letter on the unfairness of the insurance company and how my quality of life will be effected greatly if I stop getting monthly treatments. I do not want to be bound to prescription drugs to control my pain. She reasoned with me; she tried to at least. There was nothing that she could do because the status of the appeals are in the hands of their contractors in Jacksonville, FL. I’ve sent individual letters associated to the appeals to the contractor on April 16 – but apparently they have 120 days to respond. What if they didn’t get my letters? What if I filled something out wrong? Will my status be determined fail because I dont know what the f** I am doing?

— After the 20 minute conversation with Medicare; I realized it was going nowhere. I would have to contact the University of Michigan medical department to submit a preauthorization of this treatment so I do not get the run around every time and appeal the process. It’s like a never-ending story.

As soon as our conversation ended, I had to switch gears immediately because a client was going to call any moment. I had a phone conference scheduled but did not know that I would have to consult with Medicare ahead of time. My emotions were all of the place – stress, scared, worried, upset and confused. Am I going to have to deal with this process everytime I go to the hospital? Should I stop getting the treatments altoghether? I put on my boss face and took the call with charm and happiness. I would not allow my work life to be affected by something that I could not influence. My 45 minute conference with the client uplifted my spirits.. my clients appreciate me; they love my work which makes my world go round.

Around 5PM this evening, my advocate called.. I started to talk about this earlier in the blog. He was touching base to check on how I was doing after my doctor’s visit last week. I had 12 injections in my head, neck and shoulders – a bit sore but much needed for blocking the nerves from being in pain 24/7 by walking on crutches. I ensured that I was OK; nothing to worry about. But since I had him on the phone, I asked ;; is there a way to get past this run around of appeals? He didn’t have a response right away but was going to contact another department to see if someone could help me. Hey — it doesn’t hurt to ask. I’m going to have to stay on top of this, all the time – everything with Medicare is time-sensitive.

I was actually a bit upset when I got home tonight. I opened my mail – something from Medicare. They couldn’t find an “appeal” number associated to a letter of redetermination that I sent. Well.. haha – my organized self pulled out my folder in the filing cabinet for “current pending appeals” – I grabbed the documents sent directly from Medicare with this appeal number and made copies on my printer. I swear, it was either a slip in their system or someone was high when they mailed that letter. I copied the exact same documents with the appeal number referenced and placed in an envelope.. Are you ready for the best part? It says to sign and send back the information when I find it… I didnt see an address ANYWHERE.. geez, I’m going to have to call them again tomorrow and get the appropriate address so the letter gets to the right department.

I’m going to start crying again. I use to cry all the time when these letters came in the mail because I didnt know what to do. I started researching, calling around and trying to locate resources to help me understand this process. I went to the library to pull out papers on Social Security Administration, rights as a disabled person and insurance appeal procedures. I am so tired of this back & forth – give a person when I call; not an automated system. I just want to be financially independent where I can afford my own health coverage because apparently our system is f***ked. You heard it first.