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From: JHarper33(AT)aol.com
To: tmic-list(AT)eskimo.com
Date: Wednesday, June 04, 1997 4:51 PM
Subject: Re: Insurance info
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In a message dated 97-06-04 09:43:53 EDT, you write:
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> 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
=20
> 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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=
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> ---
> =20
> From: CaseyNotes(AT)aol.com
> To: tmic-list(AT)eskimo.com
> Date: Wednesday, June 04, 1997 8:50 AM
> Subject: Re: Insurance info
> =20
> I would like to hear about people's experience with insurance =
overall.
=20
> 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
=20
=20
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. What is going to =
happen to the delivery of care with $115 billion slashed from the =
Medicare budget? The closure of hospitals and the move to managed for =
profit care . The question of "who decides" what level of care is =
determined by the battle itself to transform this system . A national =
health plan will never occure under the context of this current system. =
We need a VISION of what type of society we want . This vision must =
obviously include not only healthcare, but providing for those unable or =
not needed for work, quality of life issues in the community, education =
etc. Given the technological level the productive process is at in this =
country, all these things and more are possible.With regards to "self =
employed" mantra being discussed. The goal of insurance is to make =
profit. This happens by collecting $ from the 'not sick' and =
eliminating the 'sick' from the role. The environment of managed care, =
which essentially translates to non care, means no in patient therapy, =
no PT in the home beyond some abstract point, co pay for service etc etc =
etc.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
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