> The situation regarding insurance in America is not good. As a Registered
> Nurse and a pt with a myleopathy, there is no way out of the current
> situation regarding the need for a national health plan. The question that
> needs to be addressed is will this social order care for people who they
can
> no longer exploit in the job market ? The question is clear, if one views
it
> from an unemotional perspective. Michael
>
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> ---
>
> From: CaseyNotes(AT)aol.com
> To: tmic-list(AT)eskimo.com
> Date: Wednesday, June 04, 1997 8:50 AM
> Subject: Re: Insurance info
>
> I would like to hear about people's experience with insurance overall.
> My
> husband has TM and wants to leave his job this August, but we are
> worried
> about insurance. We want to be self-employed. Any advice out there?
> Since TM nearly always is a one-episode event has anyone been able to
> get a
> doc to write a letter stating that for insurance purposes??
> Thanks.
> Carolyn Casey
I don't want to start an argument, but I'd like to pass along these
thoughts: the government can't give anything without taking first. Also, the
government is not known for its efficiency in anything it does. I really
don't know if I want it managing my health care. But I guess both points
could be made about insurance companies, also. At this point I don't have any
better ideas. We have several on the list from other countries: how is your
health care system, especially in regards to your TM?
We only had two problems with our insurance. One was that they would
not cover the drs. recommendation that I go into the rehab unit of the
hospital for 10 days. I didn't want to do that, anyway; I wanted to go home.
But I didn't feel they had the right to determine what my treatment would be.
I did have physical therapy through home health care three times a week for
three months and was very pleased with it. The insurance did cover that,
after some talking (first they wanted me to go to a place an hour away. I
couldn't drive, my husband needed to work, we don't have any family here to
help with things like that. etc. It would've been a mess.) I don't
know if there may have been a difference in quality between PT at home or in
a hospital. I felt the therapist I had did great with helping me to adjust to
the environment I was actually in, rather than an artificial one.
The second problem was getting the insurance to pay everything it was
supposed to. We kept getting notices from them and from the hospital and my
husband had to make multitudes of phone calls, but everything finally was
taken care of.
I just remembered a third problem. When I first went to the ER of our
small town hospital (with no neurologist on staff), they made an appt. for me
with a neurologist's office without checking first to see whether that dr.
worked with our insurance. We got there and found out he didn't. We called
out insurance co. from his office, explained that we had followed their
rules, and this was a referral made from one of their drs. at one of their
hospitals and we felt they should cover this out-of-network dr. under the
circumstances. The insurance guy was unmoved and uncaring. We ended up having
to go to the ER of another hospital 45 minutes away. Ironically, the dr. who
saw me there was from that same practice, and the insurance did cover her
under those circumstances because she was the neurologist on call for the
night.
Other than that, they've been great. They've covered the different
medications I've tried with no arguments at all.
Has anyone had trouble getting coverage after changing companies with a
TM diagnosis as a "pre-existing" condition? I am concerned about that if my
husband ever changes jobs.
Barbara