Scam Artist. Prejudiced, much?

workcover-fraud-exaggerated

Yesterday was not a good day.  I’d pre-arranged an appointment to discuss whatever is needed by my employer’s Insurance Agent (the Agent) in order to make a decision on my disability certification by my doctor.

The Agent assigned to me, I-Reject-Your-Reality-2 (we’ll just think of her like this image for the rest of our remaining blogs) is NEVER available when I call, but can spend 20+ minutes with me on hold, and with other’s talking to her while inefficient “messages” get communicated between the Agent, the call center Rep, and Me.  Frustrating.

This is the “insurance” benefit “game”, however, I accept that I don’t get to challenge the status quo, ask for a ruling, or anything else, until the Agent is done with me.  So, I wish she’d just hurry up.  Seriously.

The Agent is only the first step in this process.  To have her leave me a voicemail (and then unilaterally cancel my SCHEDULED appointment) is maddening.  Especially since this isn’t the first time I’ve tried to reach out to her, and she has a history of avoiding all calls.

So, I did the thing I dread most – I escalated to the Agent’s Supervisor.  Hairpuller

While better than the initial Agent, I swear to God this woman needs to get a clue about the fact that my goal is to get to the Feds vs. staying on company-paid disability.  You know, those benefits I worked to EARN for the last 40+ years.  She made it clear that my timetable for paying rent at the end of this month was irrelevant, and that they’d do things when they felt like doing things.  November 4th was soon enough to get back to me.

So, I went into overdrive, explaining my frustration with the process, the fact that it costs me $133 every time I go to the doctor (because he wants my “help” completing the forms).  I explained that I already had an appointment for 11:15 yesterday morning to fill out the State-required forms as well as the Agent-required Dr.’s Task List form, and wanted to be sure that there were no other forms that would be popping onto my horizon (think whack-a-mole for bureaucracy) as the doctor doesn’t do paperwork, and I’d been submitting his manually-approved forms to comply with their requirements for both of us.  Her Agent’s lack of customer focus will probably cost me another $133 and time wasted due to inefficiency because she didn’t think my time was valuable and canceled the call without having the courtesy to tell me to ‘go away’ to my face.

Overwhelmed Paperwork Woman

Once the Supervisor  heard my explanation about why I was so frustrated to be on the phone with her AFTER the doctor’s appointment, she seemed to actually stop her rehearsed speech and start listening to me.  So, now I feel like I’ve given her more ammunition to shoot down my claim, as the typical questions and answers went something like this:

“Q:  You said you swim daily.  That seems pretty active.

A:  I have to swim as it’s the only safe exercise I’m allowed.  I go swimming, and come home and sleep for an hour or two, as I have no breath to keep moving.  Once my energy is recharged, I’m then able to get back up and try again to deal with the world.

Q:  Do you have help in the home?

A:  No.  I don’t have the money, and I don’t want to deal with strangers in my home.  It’s a mess.  I only have physical energy for about 2 and a half hours a day.  If I’m wiped out, it has to wait for another day.

Q:  Do you use oxygen?

A:  No.  We just passed the Dignity law, and if it comes to that point, I already know what I’m choosing.  Look, this is a birth defect.  I’ve had 6 surgeries, and I decided a long time ago “no more surgery”.  The Doc wants me to consider a lung transplant, and I’m not doing that either.

I’ve had 4 car accidents – another one last week because I was pushing myself and doing more than I should in a short period of time – and I’m trying to learn how to pace myself.  Stopping work is not my first choice.

Don’t you think I’d prefer to be earning my paycheck if I could keep up?  I asked that of my boss in August when this whole thing started, “Is there another job I can do?  Can you see me finding a way to fit in and keep on working?” and they had no idea what to do with me.  Believe me, I’d much rather get paid for working than be filling out paperwork and worrying where the money is going to come from to take care of myself.”  Or something along those lines.  I talk way too much when I’m frustrated.

So, because I was in the middle of dealing with her own prejudice, I probably said way more than I was supposed to be saying.

But, she made it clear that her “Clinicians” (i.e., Nurses) had looked at what I’d submitted so far, and felt that I didn’t qualify, or that they still had questions.  Ah, the Accountants / Nurses feel the Doctor is wrong.  What a surprise !

DoctorYet

So then I made the biggest mistake of all (possibly) as I told her to go back and look at the breathing tests.  I’m way under what the Social Security Disability Insurance Blue Book says is the minimum standard for keeping working, and the side effects from taking the medicines (vision problems, arthritis, back and neck pain, rashes, etc., etc., etc.) weren’t worth the minor improvement in my breathing levels.  Which, by the way, are STILL under the SSDI Blue Book minimums.

I’m ok with knowing that I’m going to not survive this disease.  It’s the battle to keep daily living together that’s going to exhaust me. And my big mouth, for being frustrated with this process, despite my best ability to keep my temper in check and be patient with the process.  She asked me to send in a history of my activities, medical-wise, so I did.  We’ll see if the trip to Australia and vacations in March and June (which also list my progress to stay active and deal with pain – something I’ve always tracked) will help me (as bucket list items) or hurt me.

At any rate, the upshot of the conversation went like this:  because I’m not visibly disabled, I’m seen as a scam artist.

I’m ok with whatever b.s. title they want to imply, as my goal is not to deal with them but deal with the Feds.  Since I can’t get to the disability lawyer until the employer’s insurance Agent and the State reject my claim, let’s just move along to that decision.  I’d prefer to get benefits (although I have now applied for a loan against my 401K to ensure I can keep a roof over my head for the next few months while this fight continues), but if the answer is going to be “no”, then could we please hurry up and get to that point?

coherent

Today starts another day, so we’ll see if that original Agent is going to make a decision one way or the other, if the Supervisor is going to prod her, or if it’s going to drag out few weeks or so.

On a good note… the $5,500 CT scan which the same insurance agency (different branch) refused to pay for in May?  Well, I’d just decided to sic the Healthcare Advocate on them, and – surprise, surprise, surprise – they FINALLY reversed their opinion about the “experimental” nature of the danged x-ray, and did a partial payment.  I have to cover $845, but it’s MUCH better than having to come up with $5,500.

Not bad… for taking almost five (5) freaking months to make a ruling !

Space Alien Medical Tests

Happy Thursday, and I’m hoping for a peaceful day of recharging and trying to get my neck and shoulder muscles to relax.  No more computer for me today.  Or, since I’m addicted, at least not for a few hours…

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s