Category Archives: Multiple Sclerosis

A discussion with John Hancock……

Caregivers, Humor, Medicare, Multiple Sclerosis, Uncategorized, , , ,

One day a letter came from John Hancock (not the real one, I’m pretty sure he died a while ago) stating that my brother-in-law had a small long term care insurance policy in effect left over from his employment.

Every little bit helps.

So I called John Hancock to see how we could begin using the benefits, as he clearly qualifies based on the policy I had them send to me for review.

“Hello? I would like to file a claim for long term care benefits.”

“Ok, I need to ask a few questions,” said the nice polite young lady from John Hancock.

“Who are you?” she asked.

“I am his sister-in-law and his Power of Attorney.”

“Well, ok, you need to send us a copy of the POA.”

“Yes, I can do that, in the meantime can you send me the application for benefits.”

“Yes, I will send it to his address.”

At that point, I noticed that they had the wrong zip code for his address.

“I see you have the correct street address, but the wrong zip code. Can you correct that before you send it?”

“Oh, no, I’m sorry, I can’t change anything of his until you send me the POA.”

“But if you send it out, it will go to the wrong place.”

“Oh, yes, I see that. Well, would you like me to send the documents to your address?”

I pause for just a nano second, because experience has told me not to interrupt the ridiculous if it is in my favor.

“Yeah, sure, send it directly to me.”

I gave her my address.

“Now will you be filing that within one week?” she asked me.

“Well, he’s in the hospital for a few days, and may go to a nursing home for rehab or he may come directly  home and rehab there, ” I told her.

“Oh, well then you have to call back and request the forms after he gets home.”

“But it’s long term care insurance,” I said, “either way he will be under long term care.”

“I’m sorry, but I can’t send the forms until he’s home.”

“So,” I say through tears…..of laughter, “you can’t send the forms for long term care until he’s home and not in long term care. And then you can send it to my address until I get you  a copy of the POA to correct his address.”

“Yes!” she says brightly, that’s exactly correct!”080

You just have to Laugh…..”

Cathy Sikorski

Less Shark, More Beer……………

Caregivers, Humor, Multiple Sclerosis, Uncategorized, , , ,

“L” the newly diagnosed diabetic has my mom call me to ask:

“Do you have a list of foods that are good for him to eat?”

“Why, yes, yes I do. The list is in the white folder from the hospital.  Why? What is his concern?”

“He doesn’t know if he can eat a sweet potato?”

I’m guessing because it has the word ‘sweet’ in it.

“Yes, I say, “sweet potato is ok, but white potatoes, not so much.”

“Well, ” my mom says, “he’s drinking a beer now.”

A BEER?

“Yeah, a beer is wheat and sugar..that’s a no.”

“He says he doesn’t care, he’s gonna’ drink it anyway.”

So………………………the potato question………………….?????

“You just have to Laugh…..”

Cathy Sikorski

Angels and Sharks…….

Caregivers, Humor, Medicare, Multiple Sclerosis, Uncategorized, , , ,
Shark in my beer!
Shark!

Angels really are everywhere.  As are shark infested waters. You just have to be aware of both.  As I was trying to get the best possible care for “L” in the hospital this week I was ‘attacked’ and rewarded at the most unsuspecting times.

 

 

After three days of hemming and hawing about how to address his pressure sores, the surgeon did a procedure bed side and decided that he needed to go in surgically the next day. When I came to get a progress report, the caseworker informed me that “L” would have surgery at 1:00 P.M.(give or take a few hours) and then would be immediately sent home.

“No,” I said calmly, the first time.

The caseworker just looked at me with a questioning glance.

“No,” I said calmly the second time. “He’s not having surgery and then put in an ambulance on a gurney with a huge wound on his backside and then sent home where he lives alone and I have to put caregivers in place. Especially since you have no idea when  that is.”

“Well, I understand,” said the caseworker, “but the doctor said he can go home.”

“Well,” I said, “if you understand, then you can tell the doctor the he doesn’t understand, and that this patient, who is non-ambulatory and needs care cannot go home ten minutes after surgery.”

We went round and round a few more times, and it wasn’t a square dance.  Finally she left and returned with the ‘good news’ that he could stay over night after the surgery. What she didn’t know,( or maybe she did as I just was saying: “No, no, no, no, no, no….oh yeah, and no.”) was that I would probably have stood in the doorway with both arms held onto either side refusing to let them take him out.

Angels or Angelicas are everywhere.
Angels or Angelicas are everywhere.

Everything goes well, and we get him home. I entice my sister and her husband to come for a lasagna dinner. It is a sham. I want them, a nurse and a mechanic to figure out a way to invent a seat cushion that will take the pressure off  “L’s” bum. They are kind and helpful and come to L’s apartment the next night. My sister expertly moves and manipulates ‘L’ in his bed so he stays off the sores. It’s poetry in motion how she tells us what to do and how to do it. Meanwhile her husband is taking measurements and cogitating on an invention for the wheelchair seat.

Then his caregivers show up. They take the reins and say, “don’t worry, we will make sure he is turned, fed, his blood sugar is checked and he stays clean.” I am so blessed.

I come in the next day, there is “L” completely naked, having a nice lunch, and saying: “I decided it’s easier for everyone if I just stay naked.” And while on some level that’s true, I really hope the cleaning lady skips this week.

Angels and Sharks, Angels and Sharks.

“You just have to Laugh……”

Cathy Sikorski

 

 

 

Sailed right back into it…….

Caregivers, Humor, Medicare, Multiple Sclerosis, Uncategorized, , , , ,

Lest   (yes, I used the word “lest”) you think a caregiver ever gets a true vacation. Think again. I do not deride my fabulous time in Key West as anything but spectacular and so needed. And I am grateful, truly I am.

A Caregiver's Dream!
A Caregiver’s Dream!

And just as I was winding down that lovely time in the sand and sun and wine and dine, the phone calls began. Trouble was brewing and you, oh mighty caregiver, you were needed pronto.

One of the several disasters going on was that Aetna, once again denied an ambulance transport. I know. I know. We are all so very tired of this same story. But it just gets better and better.

Before I left on vacation, I went to the doctor’s office, who ordered the MRI, gave them a copy of the denial and asked them to write a letter explaining that my brother-in-law is not at all ambulatory and needed the gurney so that he could be lifted on to the MRI table and then transported back home. The woman who handles that task was out to lunch. Oh please, that joke is just too ripe for the picking!

“Hello, is this Cathy?”

“Yes, this is the administrator from the doctor’s office. I did get a call from Aetna and told them we did not order an ambulance for your dad (yea, sometimes I’m his daughter, sister, wife, whatever works). And when they said a ‘Cathy’ called I told them it was his daughter. So that’s why they denied it. ”

First of all, thank you? Thank you for telling them you didn’t order the ambulance and for not explaining that you did though, order the test, and that he would need an ambulance to get there.

What I said was:

“Yes, I called Aetna because for the last three years, your office refused to do that, and so I made the call to get him to the test. You see, he’s not ambulatory so he can’t have any tests on a table unless he goes by gurney.”

“Oh that’s not true, he could go by wheelchair.”

Yep. She really said that. Or she was still out to lunch. I’m not sure which.

“Noooooooooooooo…..he can’t get out of the chair and up on the MRI table.”

Dead silence.

“Well,” said the administrator, “I’m going to have  to have to check with the doctor. We’ve never written a letter before for something like this.

See, not only have they done this before, but I actually sat at the desk with the last administrator and helped her write the letter.

“So, if the doctor approves this, in the future will you call the ambulance for any test he might order?”

“Oh no. We don’t do that.”

You have to go on vacation and then……………

“You just have to Laugh….”

Cathy Sikorski

What do a Pediatrician and Blanche DuBois have in common?

Caregivers, Humor, Medicare, Multiple Sclerosis, Uncategorized, , , , , , ,
Fun at the Pediatric Dentist!
Fun at the Pediatric Dentist!

I have been searching for 2 years for a dentist to treat my brother-in-law, “L” who has MS. The issue is that L is wheelchair bound and cannot get out of the chair at all without the assistance of at least two people or a Hoyer Lift.

The dentist, eye doctor and any other pyhysician or medical facility that we have to go to, must have a wide enough room for him to enter, leave, turn around and be treated in. Thanks in great part to the Americans With Disabilities Act, most medical facilities have come to the place where L can be accommodated. But the dentist is a challenge.

Most dental offices here in Smalltown, USA are converted homes and even if we could get into the lobby, we can’t get into the treatment room. And on top of all that, since L can ‘t move from his chair to the dental chair, many dental offices I have contacted would not see him.

To be fair, his own dentist offered to try and get the lift from the wheelchair van to come even with the outside deck of the dental office, and then maybe we could skootch him through the glass sliding doors and into treatment. And I considered it until we had snowstorm after blizzard after ice storm.

And then L broke a tooth.

Now I had to put this into high gear.

I called the MS Society, who put me in touch with a dentist who was far away. Kindly, that dentist agreed to see him, but had no openings for 3 weeks. I called my own dentist who had no access at his office, but I thought he would have a recommendation. The first office was unable to help me. The second dentist was a pediatric dentist, so I was pretty sure that was going to be a wash. Never assume.

Pediatric Dentist, Dr. Zale, agreed to see L. We entered the office and were immediately surrounded by picture books, Legos, toys for every age, and a beautiful array of kids from toddler to teen. I told L not to smile too much because the broken canine in his mouth might scare the little ones. But those kids played around the wheelchair like it was a dining room chair at home. If the toy they wanted was on the other side of L, they just looked him straight in the eye and walked around him to play.

Dr. Zale and his staff took my brother-in-law into a very large and airy treatment room, somehow got him x-rayed and fixed him right up. There was no time to do a standard cleaning so they made an appointment for him to return before I even got back to the desk to pay. He was now their actual patient!

Six weeks later, the Jeff Gordon of wheelchair drivers, my brother-in-law, hits the high speed button on his wheelchair, bonks his head on his computer and completely breaks off the new tooth. I called Dr. Zale, they got him right in and took yet another two hours to fix that smile right up. Because it had taken longer than they expected the front desk ladies said they would just send me the bill. This is the bill I received:

No Charge per Dr. Zale..
No Charge per Dr. Zale..

Sometimes you just have to be ever so grateful for the kindness of strangers,  and

You still just have to Laugh…….

Cathy Sikorski

When wine and wheelchairs DO mix…..part deux

Caregivers, Humor, Multiple Sclerosis, Uncategorized, , ,

If you have been living in the Snowmaggedon part of the US this 2014, you know how desperately we all want sunshine and warmth. My last post was from a teeny jaunt to Florida and I was somehow lulled into thinking that going away meant being away.

Day Three: My friend and I are getting ready to go out to the extra special dinner we have planned for the trip. We are going to a five star restaurant to be wined and dined. We have been lolling in the sunshine, chatting for hours and resting in the warm, balmy air of Florida.

“Hello?” I already recognize the phone number, Chestnut Knoll at Home, and know it’s not good.

“Cathy? This is your brother-in-law’s caregivers. His wheelchair is broken in the lying back position, and we can’t get it to move. And it’s time for his dinner.”

All I can picture is the poor guy laying back like in a dentist’s chair trying to get some peas into his upside down mouth.

“Okay,” I say,” let me call the wheelchair repair guy, because this is their rental that they just brought him yesterday.”

Of course, it is 5:00. I’m in a bathrobe, wet hair, no make-up, our taxi is coming in a half-hour AND, I’m pretty sure wheelchair repair guy closes at 5:00.

I call the repair office, closed. I call the salesman in my phone that I have listed as ‘wheelchair Sean’ and leave a message. I do what every caregiver does. I call my mom.

“Mom, I left messages for the wheelchair repair guy but I don’t know if they will get back to me. The caregivers suggested we get a hospital tray and put him back in bed, but I don’t think that makes sense.”

My mom is 85 years old. A REALLY GOOD 85 years old, but I can’t picture her hustling a huge hospital tray on wheels into her car and over to my brother-in-law’s for dinner.

“Okay,” she says, I’ll just go over there and help feed him.”

I call back the caregivers at my brother-in-law’s phone but they don’t answer. I call their office and we formulate a plan for Mom to feed him now, they will feed him breakfast and hopefully the repair guy will get there before lunch and they can get him back in the chair by then.

My phone rings, I’m still in my bathrobe.

“Hi.” It’s wheelchair Sean. He gives me some simple directions on how to probably fix the chair.

I call the caregivers at my brother-in-law’s phone again. Still no answer. I call the office, give them the instructions. They call me back in 2 minutes, saying crisis averted, chair fixed.

I throw the phone at my friend and tell her to call my mom probably driving in her car and tell her to go home.

“Hello?” I hear my  Mom answer, as I’m putting on a face in the bathroom, and trying to get on underwear before the taxi gets here.

My friend says to my Mom: “You can go home, the wheelchair is fixed.”

“I can go home?” my Mom says. “Yes, go home, he’s fine,” my friend tells her.

“Okay, thanks. I’ll go home,” my Mom says, “ummm, WHO is this?” Explanations ensue.

My friend and I go to an absolutely lovely dinner where we are treated like princesses. We have a bottle of wine, oysters Rockefeller…my phone rings.

“Hello?”

“Hey, it’s your brother-in-law.”

“Hi, is everything ok?”

“Well, yeah, YOU called me. What did you want?”

Really?

“Oh, nothing,” I say and dive into my Pinot Grigio.

You just have to Laugh…….

Cathy Sikorski

When wine and wheelchairs don’t mix……

Caregivers, Humor, Multiple Sclerosis, Uncategorized, , , , ,

What do several rocket scientists, a computer nerd, a lawyer, a doctor, an industrial inventor a, a plumber and a nurse have in common? Let’s see………..

The day of the engagement party finally arrived. It was an unusually cool and delightful August evening. The bride-to-be was resplendent in an adorable white frock, the groom-to-be handsome and convivial with all the guests from young to old.  Because Uncle L was confined to a wheelchair from his MS, many things were put in place to make sure he could attend the party. He was an important part of the family and we all wanted him there, and he was game to go out and be with friends and family.

It was just lovely, We were really having a wonderful time. Uncle L had a nice Jack Daniels, his favorite adult beverage, and enjoyed several of the fancy hors d’oeuvres. When it came time for the buffet dinner, there weren’t enough clucking hens of mothers, nieces, sisters-in-law to fill his plate and keep his mustache clean. Of course, he was at the “cool table” where all the middle-aged people think they’re the coolest with lots of joking, insults and free flowing wine. Even Uncle L was not spared a joke or two…just like old times.

With so much taken away by that dastardly MS and the wheelchair, we all made allowances for Uncle L’s one vice-smoking. So after dinner, Uncle L wanted to go outside for a smoke. A couple of smoking cohorts joined him to proceed to the parking lot. No go. No, seriously, the wheelchair no go.

First they called me, the caregiver/lawyer. What did I do? I pushed the button that says “go.” That didn’t work. I thought about saying, “objection!” but was pretty sure that was a waste of time. Then we called over the rocket scientists and the computer guy. Hmmm, look at this, push that, fiddle here and there. Nope, nuthin’. The plumber, the nurse and the doctor wisely said, “well, we will all just have to push the chair.” This chair weighs a ton, even without a big guy in it.

So all the big guys got together pushed the chair to the transport, we got into three separate cars to meet at Uncle L’s home to get him back into his room in time for the  caregivers to get him to bed. We were a little late and God Bless these amazing caregivers who have never let us down at Chestnut Knoll at Home (I promised them I would give them a plug whenever I could as the minimum of thanks) who called me to find out where Uncle L was.

We get him and the super heavy chair out of the transport with lots of brawn and maneuvering, and they put him to bed.

The next morning I get a call from one of the lovely ladies of Chestnut Knoll at Home to tell me that I could call off the repairman I sent an emergency call to last night. She fixed the chair just by making sure the plug was connected in the back.

You just have to Laugh………

Cathy Sikorski

And the Winner is…………….

Caregivers, Humor, Multiple Sclerosis, Uncategorized, , , , , , , , ,

As every caregiver knows, I have been frustrated so often by insurance companies and physicians offices that I, well…started a blog.

If  you’ve read my : Never call an ambulance if  you’re old…..Part 2  and  Ambulance…”part trois”….., you know that one of Medicare‘s absurd rules is how to transport the infirm. They will pay for transport from facility to facility, but they will not pay for transport from your home to any medical appointment or hospital test (with certain exceptions). So, if you are completely wheel chair bound, like my brother-in-law, have no use of your legs, and your doctor orders a CAT Scan or MRI, or even the lowly X-ray, you:

A.  Can’t get there

B.  Can’t get ON the table when you get there

C.  Better have a bucket of cash stowed somewhere to pay for private transport

After days, weeks and months of figuring out the rules, and hacking at the system. I found that if my brother-in-law could be transported upright, so that he didn’t have to get out of the wheelchair, he would have to make all the arrangements with the ambulance company and pay for it himself.

If, however, he needed to get on to a medical table for any kind of test or examination AND the test or examination was at a hospital, then Medicare would pay for the ambulance and I would still have to make all the arrangements for transport.

This is how I found that out.

Medicare denied payment of a transport for a CAT scan. I followed all the rules, contacted all the right people. Got all the pre-certs, the approval numbers and the referrals. But since I had already scheduled the scan, I just used the information the insurance company gave me and had the test done.

Several weeks later, I get the denial for payment. I made a thousand phone calls, appealed the decision, twice, and was still denied as transport not an emergency or medically necessary.

Now I had to appeal to an Administrative Law Judge. This law degree I have and over 15 years of practice in Elder Law came in handy. I jump in with both feet and file the appeal. But because I’ve been around this block many times with many people, I know that a simple paper appeal will not work. Short of asking the ALJ to come to my brother-in-law’s apartment and see how the hired caregivers get him ready for the day, I’m pretty sure the information I would send would not shift the decision.

Yay….social media…..Yay….youtube.

I get up very early in the morning and with my brother-in-law’s approval, I take that amazing little iPhone I have and make a movie of the two caregivers dressing him, washing him, lifting him out of his bed and into his wheelchair, combing his hair,  helping him brush his teeth and shave, and giving him a nice pat on the head to have a good day.

I make a copy of the video, put it on a CD (yeah the Medicare appeal system isn’t that tech savvy that I could upload it), mail it to the judge, and wait.

Lo and behold after 3 hearing cancellations by the insurance company, I get a phone call from the judge’s office saying that the insurance company has decided to pay the claim and there would be no hearing.

I take a bow and accept my Oscar for best performance by  a caregiver.

You just have to Laugh……

Cathy Sikorski

When naughty is nice……

Caregivers, Humor, Multiple Sclerosis, Uncategorized, , , ,

I have done something very naughty. I must even go so far as to admit I have done it on purpose. You will probably not agree with my decision, but in the end, was I right? If you’ve read any of my blogs….you know the answer to that.

Being a caregiver puts you in the ‘decider’ seat  more times than you care to admit. And sometimes you don’t want to be George W. Bush….you WANT someone else to be the decider. But alas, you’re it. You are the caregiver.

The hired caregivers, who do all the hard stuff, the bathing, the dressing, the cleaning up, keeping the list of needed items, they gladly call on the decider when well, when decisions must be made.

So, I get a call from Susan, head honcho caregiver:

“Cathy, your brother-in-law, is acting weird.”

“Weirder than usual,” I say, hoping that this is just happy conversation, knowing all the while that I am in for a project.

“No, not usual weird—- cranky, mean and kind of ‘out of it’ weird”, she says weirdly, knowing that I KNOW she wouldn’t call me unless there was a problem to be solved.

“Hmmmm, that sounds like, ‘you-know-what’, doesn’t it,” I say with regret.

“Yup,” she says, ” a UTI” (everyone’s worst caregiving enemy…the urinary tract infection). ” He’s weird, he’s ornery and his urine looks a little tinged with brown. So that ‘s not good.”

“Okey doke,” I say with false upbeat. “I’ll call the visiting nurse he has right now and get her to call the doctor.”

Now the reason I have to go this Chutes and Ladders way is because I have no medical authority to call the doctor and beg for an antibiotic, but since he just happens to be suffering from a bed sore right now, he has a visiting nurse once a week who I can ensnare to do my dirty work.

“Hello, Visiting Nurse? I want to ensnare you to do my dirty work,” Okay I really don’t say that.

“Hello, Visiting Nurse? I got a call from the caregivers and they think his behavior and his urine suggest a UTI. I would be ever so grateful if you would call his doctor for a prescription because it’s Friday, I can’t get him to the doctor for at least three days, and if it gets too far gone, he usually ends up in the hospital.”

“Ok,” says the Visiting Nurse, “I will call this morning and get back to you.”

By 4 o’clock, I haven’t heard from anyone. So I call the pharmacist to see if there is a prescription waiting. No, of course not. So I call the doctor’s office.

“Hi, I’m call because I know the Visiting Nurse called and the pharmacy  has no prescription.”

“Yes, we see that the Visiting Nurse called this morning, and it’s in the doctor’s inbox to process.”

“I understand that the doctor is busy,”I say patiently (really  I do) but it’s Friday afternoon, and these UTI’s can be very dangerous for this guy….so if you could just see if he can get it processed tonight……”

“I’ll put a reminder on it,” says the receptionist.

So, of course, at 8:30 that night the Visiting Nurse calls to tell me they called in a prescription, with the caveat that the nurse would take a urine sample and have it to the lab BEFORE we give him the medicine, just to make sure.

So she gets the sample (that’s it’s own blog, I’m sure). I get the meds into him the next morning, and two days later they call and tell me the sample is negative.

And here’s where I’m naughty.

Years ago, when my kids were toddlers, they would suffer from chronic ear infections. I would see it coming, take them to the pediatrician, no red ears would appear in the otoscope, and the pediatrician would send me home. A day or two later, I would be right back in that office with a kid with DOUBLE ear infections, because the symptoms were obvious to me, but not yet to the otoscope. And pretty much, every time, Dr. MOM was right.

Soooooo………I just kept on giving that antibiotic to my brother-in-law since his symptoms were so obvious to all of us caregivers, he gets really, really, REALLY sick if he gets an untreated UTI, and I just was willing to go for it. I am the decider.

I know. I know. Too many antibiotics, too must MERSA, too many super bugs. I know.

But here’s the kicker. THREE DAYS LATER, the doctors office calls me and says.

“Well, you know the test was negative for an infection, but all the other markers were questionable, and so we thought an infection was on the horizon, so just finish the antibiotic as given.

Yup, DR. MOM!!!!

You just have to Laugh……..

Cathy Sikorski

Just searching for approval….not PRE-approval

Caregivers, Humor, Medicare, Multiple Sclerosis, Uncategorized, , , , ,

I have been so lucky with my brother-in-law, L this  past year. He has been pretty healthy for a guy with MS and relegated to a power wheel chair. The year before he was very sick off and on and required boat loads of my time. But this year, he has just been doing remarkably well, which led me into this complacent place of thinking all is well in the medical world….at least with L.

And actually, he’s fine–ish. But we are now in a push to get some testing and medical work done before the end of the year. And I just forgot how to do things, and how things would be done to me.

On Monday, L needs an ultrasound to check a worrisome kidney cyst. Okay,  I set up the test at the correct hospital and the correct facility of the hospital. His Medicare insurance requires him to go to certain facilities. Sometimes the ordering physician knows that and sometimes he doesn’t. But after 10 years, I KNOW it and so I set up as many of these tests without their “help”, so we don’t have insurance issues in the future.

I make sure the test is between his breakfast and his dinner, because even though he’s gained at least 40 pounds in the last three years, he gets really cranky if he misses a meal. I get that….it’s part social, part his inalienable right, and part “I’m hungry!!”. Okay, no sweat.

I call the ambulance transport and set up transport to the facility and the eventual doctor’s appointment to discuss the results of the test. And I even make sure the blood work is scheduled to be done at his apartment as a “home draw”, which requires a request to the lab directly from the doctor’s office, because I am not PERMITTED to ask the lab to come to his apartment, since  he is wheelchair bound and has no  transportation….ONLY the doctor can do that. (who of course, doesn’t ever remember that and so must be reminded by me, and then the lab calls me to make sure they can come at a convenient time…UGH does this really make ANY SENSE TO ANYONE????)

And then I realize, three days later, and three days before the test. Oh crap, I didn’t get PRE-CERTIFICATION for the ambulance, which must be a gurney and not a wheel chair transport  (which we will discuss another day) because he must be put on a table for an ultrasound and he cannot get out of the chair and onto a table by himself.

So…………….I call for the pre-certification:

“Hello, I’m calling for a pre-certification.” (This of course, after pushing 42 buttons and getting disconnected, and being asked at least four times: “are you calling for a pre-certification?)

“Okay, can I have the name of the member, his ID number, his date of birth, his first born.”.(okay they didn’t ask for that, but they might as well have)

And after I get it all squared away, I think…

“Now, you will have to have the ambulance transport company call us to request that.”

“Well, I’ve tried that before. First of all, they won’t do that. Second, in order to request this you need the prescription, the diagnosis code and the physician’s name, am I correct?”

“Well, yes, so that we can approve that it is medically necessary for him to have transport.”

“Well, the ambulance company does not have the prescription, I do. And furthermore, I wouldn’t give it to them, nor do they want all this medical information on my brother-in-law. Not to mention that I’m pretty sure it would violate like 100 kinds of HIPPA laws to be passing around his diagnosis and doctor names and medical test information, don’t ya’ think?”

“Umm, well………Can you hold for just a second?” the nice lady at the insurance company says to me (the mean lady trying to get ambulance transport for the hundredth time with the same argument for the past three years)

“Okay,” she says as she comes back on the line, “can you give me all of that prescription information?”

“Of course,” I say. NOW, I hope against hope that we are really almost there.

“Well,” she says, “that will do it!” Very bright and chipper I might add!

“Oh, no, no, no,” says the voice of experience, “I need an authorization number,” knowing full well that the ambulance company won’t transport without it.

“Well, okay, I can give that to you, but this has to go to our medical team to determine if it’s approved. You will get a confirmation in 2 to 3 days.”

“Okay,” I say, “just give me the number.”

Because I know their dirty little secret. They will approve this BY MAIL in a week, if I’m lucky. But I will not cancel the test, because they will put on their approval that the transport is approved for the day of the test, effectively making it retroactive. But if  I wait for pre-approval, I will magically have to know when the approval will come in to schedule the test since they only approve a specific date. Don’t overthink it. It’s complicated and stupid. I’ve played this game so many times, I just know how to do it. Trust me.

 

You just have to Laugh……………………..

Cathy Sikorski

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