Tag Archives: insurance

With disability insurance restored, health-insurance pays for a wheel chair.

I’m happy.  Although these last few days have been unproductive, in a writing sense, several good things happened this week.

Yesterday, I cashed the check from my disability insurer.  Cigna has decided to honor my policy, after reviewing my functional capacity evaluation.

There was no explanation from them.  No correspondence.  Just a check, arriving in the mail, the night-before-last.  All the money they owed, since December.  (Here is my last post on this saga.)

Even with high-confidence in my case, I carried a low-grade anxiety into this new-year.  I guess that’s natural when no in-come matches my out-go.  Now, I can dismiss that emotion.

For some reason, I anticipated a letter explaining why they chose to make my life difficult.  But, nothing says, we’re sorry, like a check.  I suppose I could call them, to confirm that this will now be honored for the life of the policy.  I don’t want another, bad, surprise from them, next year, or next month.

I also got fitted for my wheel-chair.  Health-insurance will pay for most of it.  The features on my model will be determined by another type of functional evaluation.  Insurance requires justifications for costs.

I had a couple of choices, between manufacturers.  One is Chinese-built for American overlords.  The other is American-made for Swedish overlords.  I chose the Swedish model.  It was recommended as more reliable, with more apparent-thought behind the engineering.

The Chinese-American model left motors, and other moving parts, exposed.  The Swedish-American model has those things largely hidden inside of casings.  Both chairs share the capability of changing postures and heights.  For instance, the seat can rise, so that I can work at my kitchen counter.

The Swedish-seat lifts directly from the base, on a metal rod.  The Chinese-seat lifts with a scissors-jack.

One looked like it was designed by experienced engineers.  The other resembled a lab-project by engineering students.

Some of the capabilities of the chair might be non-functional, depending on what insurance is willing to pay.  A fully-featured electric-chair could cost something on the order of $22,000.  A less-abled model could be as low as $16,000.  I should have new mobility, in roughly a month.

My motivation for it has more to-do with leaving the house, than living within one.  In-home, I still can cope.  But, leaving the house intimidates me now, on most days.  I don’t have confidence that my strength will hold up for these trips.  Mostly, I shop for groceries, or stop at a coffee shop.

I’ll get around by bus.  Between buses, light-rail, and my chair, I can begin enjoying some public spaces again.  I’m anticipating the opportunity, just to visit a place like Mill Avenue, on a nice day.  Right now, I don’t do this anymore.  My life is mostly spent at home, with brief trips to break the day into logical pieces.

And, this past Monday, I met with a doctor I have never met, because social security is still making a decision on whether I am disabled, or not.  I didn’t choose this doctor.  I received a letter instructing me to see him, at 9:30 AM.

I offered them my functional capacity evaluation.  They declined.  Instead, they had me meet with a doctor, who interviewed me, while performing the most-cursory of physical-evaluations.  I think his task is to determine whether my story makes sense.

He has my diagnosis, and my doctors’ notes.  But, a lot has changed in the last year.

The doctor collects fees from SSI, to determine if my condition is truly disabling.  The entire visit took place in about a half-hour.  Although I could see the necessity for some type of verification, SSI’s procedures seemed lacking in credibility.

The low-point of the visit was when the doctor took apart his pen, and asked me to put it back together.  This was the ‘dexterity test’.  He told me to pretend I didn’t see him take it apart.

I wondered whether seeing the pen being broken-down helps my dexterity.  I have been taking pens apart since the second or third grade.  Visualizing, how a pen should be assembled, is more of a cognitive test.

But, I didn’t argue.  SSI needed the results before they can rule me disabled.  And, somehow, assembling a pen speaks to my ability to earn a living, or not, programming computers.  At least, the doctor seems to think so.

These events served to occupy some of my attention.  The better-part of this week, dictated by insurance.

Good thing, too.  I’m fighting my way through an inspiration-drought.  I blame some of this on my condition.  But, if I didn’t have these moments to anticipate, this week would have left me less to say.

A few, brief, thoughts.

I have been quiet the better part of a week.  Possibly, the best week of my life, in many ways.

Since my previous post, I have been in wheel-chair prescription-limbo.

It’s bizarre.  How strange our worlds?

Become, when insurance enters our lives.

It’s not my control.  It’s shared control.

In order to gain control, I have to learn how insurance companies think.  It’s what I imagine before.

The alien, suddenly, in my dreams.

And this has been possibly the best week of my life, because, for the rest of it, I have only been writing, and meditating on my manuscript. I am now in full book-writing mode.

Beam me up, Spock.

To a heavenly place.

Each day, when I begin to type.

Thoughts.  Not my own.

2014-01-28

=== 4:36 PM ===

XB

Yeah!  I got the writing table at my favorite coffee shop.  So called, because many write.  Here, over all the other tables.

I should be writing my timeline.  I had discussed it with the guy who evaluated my functional capacity.  Today he reminded me.  My timeline will help fill out his evaluation.

My timeline from my journals.  I have five years.   In them I discuss all my experiences.  Once I realized.

Their value.

Journaling keeps me sane.  I have found.  It works best if I pour my soul.  Lavishly, on the page.

And, that’s what I did.  Starting before it ever occurred to me.  Maybe I should discuss what I notice with my doctor?  The notion was vague, that the state of ship was amiss.

They cover everything from my thoughts on life and death, to the detail of each day playing out.  The ones worth remembering.

When I started using my cane.  How I thought.  Still.  That it wouldn’t get too bad.

Too soon.  It got worse.  And I discussed everything, from why I plopped onto the couch and fell asleep, right after work, to the pain that woke me in the middle of the night.  What else to do when I can’t sleep, but write?

And these journals also describe the sick days I took.  They agree with my former employer’s records.  How I never took many sick days until the last two years.  And how they grew in frequency.  And why.

I also have to write a cover letter for the evaluation report.  To the bureaucrats of the insurancy.  I want to make myself perfectly clear.

Don’t contest this any further.  You will lose.  You have no valid arguments regarding my case.

That’s essentially what it is.  Right?  Will my case stand up in a court of law?  That’s gotta be how they evaluate each one.  If we drop him, with the evidence we have seen so far, will the lawyers win?

In a suit?

So, my cover-letter needs to detail all of the evidence I have.  Just to be perfectly clear.  They will not!

It was the insight that allowed me to stop worrying about the situation.  My weakness is the strength of my case.

I need to spell it out, in my own unique way.  Because I am not merely providing the insurancy my evidence.  I am telling them how to see it.  Without ever stating my intentions directly.

I want the power of language.  Spoken.  Honestly to paint.  A picture in their minds.

I want them to see it.  From my position, they lose.

In a court of law, they have no case.  They will see it.

When I crush their collective will.

2014-01-23

A couple weeks ago I mentioned my problems with an insurance company.  This is the latest on the story.

I previously posted twice about the matter.  Here is the first.  And the second.

I rely on my disability policy from my last place of work.  I won’t name the insurance company, yet.  But, I will if it gets ugly.

They sent me a letter, two days before Christmas, telling me to go back to work.

You lazy bum!  I kept thinking the letter contained those exact words, as I read it again and again.

Yes.  I took it personal.  At first.  But, then, as I researched, I began to see.

Disability fraud is rampant.

For example.  In a couple counties bordering Kentucky and West Virginia, as much as 15% of the population receives some form of disability.  One lawyer handles most of the cases.  At 25%, this guy must be very rich, even after paying off a judge and some doctors.

My insurance company needed to know that I am not one of ‘them’.  So, as they paid my short-term disability claim, they also demanded a physical evaluation by my doctor.

But, my neurologist wouldn’t help me.  As a policy, he doesn’t provide help with disability claims.  His secretary was adamant.

I have heard hospitals and clinics commonly refuse to help with claims.  They must think it is outside the realm of medicine.  So I had to take my records back to my primary-care physician.

She had not seen me in almost two years.  I remember her smile as she asked, “What’s new?”

“Well, I have muscular dystrophy.  Here are my records from Mayo Clinic.  Will you help me?”

I saw her at least three times over the summer, as my insurance company kept hounding us.  They wanted more evidence.  Phone calls and letters.  Follow-up exams and forms.  I can see why some medical institutions won’t waste their time.

Evidently, they were never satisfied.  They were just biding their time until they could drop me.

We don’t believe you.  Go back to work.

I consulted with an attorney.  He was friendly and sympathetic.  Then we discussed fees.  He wanted 25% of the lifetime settlement!

I kept thinking, This is all I have left to survive on.  Why do you get 25%?  It’s a straightforward case.

I asked him how he thought his fee was moral.  He never answered directly.  Instead, he told me what other lawyers charge.

But, after some conversations with the insurance company, I learned what they wanted.

So, this past Monday I paid to have a functional capacity evaluation.

A functional capacity evaluation is typically performed by a physical trainer with special certifications.  A subject is put through a battery of physical examinations, as well as tests designed to simulate the type of work performed.  The evaluator summarizes his findings in an objective, legal-medical dialect of English.

In my case, there was an interview, and a review of medical records.  Followed by strength and agility exercises.  He pushed me to the point of failure, so he could to accurately describe what he was seeing.  He also took lots of photos.  As he escorted me out, afterwards, he told me what he saw, in the dialect spoken by insurance bureaucrats.

I try to see insurance professionals as people.  But, I had no sympathy for them on Monday.  By the end of the exam, I was weak and shaking.

About six hours after it began, I left for home.  Muscle spasms left me too tired to do anything.  I just tried to keep myself awake until bedtime.

Tuesday, I was still in too much pain.  But, yesterday, I started writing.  Today, I have enough energy for editing, but not much else.

I don’t, yet, know the final cost.  I will get the bill before I receive the report.  It will be somewhere between $1200 and $1600 for everything.

And, when I heard that, I thought, sure.  If that’s the cost for a report that will hold up in a court of law,  I will pay.

It’s also more palatable than what a lawyer would leave me to let me live on, in exchange for his services.

So I gladly antied-up for Monday’s torture.  I can afford the cost, both financial and physical.  And, after a week I can forget about it.

I made the decision a couple days after my second post on this matter.  And I spent the remaining time, until Monday, blissfully writing.  It was definitely worth it.

I enjoyed each productive day.  Essentially, I feel like I bought myself a two-week writing vacation.

A worry-free mind is priceless.  Especially when it is affordable.

I’m hoping this will be enough.  Common sense tells me it will be.

2014-01-06

=== 6:48 PM ===

XB

One of those days.  I wanted to call Windy Loo, my case manager, today.  Too tired.  I woke up and had a short morning before falling asleep for several hours on the couch.  I woke again this afternoon with pain coming on.

Funny, too, because yesterday I was beginning to notice how good my energy had been the past few days.  Enough energy to be planning my fight with The Demons of Insurance Underworld.

Pinch me, said my cliche.

I finally left the house sometime after 5 PM.  I first went to Harvest of Tempe for some new herb.  I bought two eighths.  One of Black Label Kush, and the other the ‘Platinum’ TrainWreck.

Then I went to Cheba Hut for a meal.  The lunch I never prepared, much less ate.  The dinner I won’t need to revisit later.  One of those days.

And now I’m in the mood to write.   Not sure if I’m journalling, or working up legal correspondence, or something for the blog or the book.

And, I’m thinking.  If I tell the insurance company about the five years of journals backing my case and my claims, are they going to want to see these things?

I’ll have to practice telling them to fuck off.  Calmly.  Confidently.

“Fuck off.  Are you going to honor the contract I have with you?  Or, do you want to be sued?  Those are your options.  You don’t get a look at my journals unless I have to sue you.”

There was a song playing while I ate my Humbolt and chips at Cheba Hut.  I asked the kids behind the counter.  Who is this?  Sounds like Bob Marley.  But, it can’t be.  This tune is contemporary.

Turns out it was Hey Baby, by Stephen Marley.  I think I may make that a CD purchase.  Do I purchase the CD now, confident I can win this case before my savings run out?  Or, do I hedge?

It’s true that everything contributes to the total sum of my expenses, but I don’t think I spend much on anything any more.  Food.  Periodic restocking of the herb stash.  Like today.  First time in a couple months.  The last purchase was November new, or the very tip of October’s tail.

I will look into the CD a bit more.  Listen first, to the song, again.  I’ll order it if I am confident it will keep.  Musical exploration helps me center myself.

Then, I’ll circle back to my case.  When I remind myself that my journals describe all the visits to doctors and hospitals to get an accurate diagnosis, and all of my sick days as I found myself able to do less and less, and the quality of my life the last few months of work, I have to think the evidence is golden.

Fear can be a bitch, though.  Why am I susceptible to fear today?  It seems related to my physical state.  Today I’m weak and in pain.  And fear of a legal wrestling match must be associated somehow with that.  Maybe one triggers the other?  Or, maybe they are similar in biological origin?

Or, perhaps they are mental.  Maybe being physically weak allows fear to take over.  If I were a small kid, I would certainly feel vulnerable facing a bully.  And, even though my weakness now is the strength of my case with the insurance company, it significantly subtracts from my motivation to pursue this.

But, I don’t have a choice.  I know I need to get on it.  First thing in the morning.  No excuses.

Today, though, I didn’t need an excuse until I woke this afternoon.  Exhausted.

And, one last thing.  It used to be when I journaled I felt comfortable during my introspection.  My thoughts are my own, I used to think.

Now, I just re-read today’s writing.  And my mental legal counsel saw the line, Not sure if I’m journalling, or working up legal correspondence, or something for the blog or the book.

Here is my legal disclaimer.  Those are my ambitions.  Those are not all the things I do each day.  Those are my choices.  How will I spend my writing today?  I only have enough energy for an hour or two.  It has to be worth my while.

And now, a message for the lawyers from the strength of my case.  If all I am able to write each day is an hour or two, how exactly am I supposed to go back to full-time work? 

Idiots.

2014-01-05

Last night I went to dinner three friends.  They were arguing that my belief, insurance companies are populated with human beings, is wrong.  And, I failed to ask them.  But I should.

Have they enjoyed their segment of conspiratorial thought?

How else could I justify my opinion?  I haven’t had any actual experiences to back up my belief.

Their voices swirled in my head as I lay myself to sleep.  I had become fearful.

Probably wasn’t thinking as much as feeling.   Subterranean embers still glowed deep beneath the cool of the evening crust.

Bad experiences remembered.  Insurance stories related.  Wrapped in a pleasant visit.

So, who’s crazy?  Me?  Or the three of them?  I guess we will see which of these two notions crystalizes in the coming weeks.

This is my first fearful experience with an insurance company.  Fearful, because my survival depends on it.  Or, at least, the quality it all.

And yet.  People do survive for a time in the gutter.  Who says I couldn’t?

Besides my common sense?

And which opinion is true?  The one based in fear?  Or the one built firmly on the calmness of knowing?

I am right.  This is an epistemology course for disabled people fighting insurance industry brutality.

Brutality? First person?

Present!  Because fighting this burns.  My daily allotment of fuel for focused mental energy has shrunk quite small.

Don’t know if my tiny budget for laser thinking is a brake on my mind, or my body, or both.  It could be any combination of the three.

Keep positive.  Gonna need it.

If my friends are right.  And because life is more enjoyable not dragging baggage everywhere.

Four and-a-half years ago I pulled a trailer of cargo on my bike to a writing retreat.

In Tucson.  End of May, the temps hover somewhere above that third digit.

One hundred miles.  One day.  That was easier then.

Because.  Retaining bad emotions exhaust me now.  Is this physical?  Or an enlightened state just before sleep?

Last night before sleep I was one.  Against three.  Both times in our thoughts.

The insurance industry and God.  Three believers and one form of dissent.  A good conversation.  And, an effective segue for next time.

God.

Well.  That’s it.  My budget spent.  I won’t work on my letter to the un-named insurance company.   Appealing their decision to stop paying my disability allowance.  Instead, I need.

Rest.