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I watched someone dear to me go through years of pain and suffering because inept doctors who no longer see the patient as a human kept putting off the inevitable surgery needed either from ignorance, or because insurance practices superseded quality of care.  Despite the increasing pain and side effects this dear person continued to be the primary income provider for the family.  The physician kept attempting to manage the issue using repetitive outpatient procedures to no avail and the insurance company continue to dictate more intensive surgery was not “deemed necessary”.  Work became increasingly difficult, life became unlivable as there was little quality of life because there were days this person could no longer stand erect!

Finally, another doctor was found who listened to the past medical history, family history and ran additional tests of their own and with all the facts in hand asked the patient “Why are you so reluctant to have the surgery?  My loved one’s response?  Only because the prior physician and the insurance company kept stating surgery was not indicated and would not be covered.

Surgery with the new surgeon was scheduled but there was a failure to verify insurance coverage and on the morning of the procedure when the patient showed up at the hospital was told that the insurance would not cover it because it was “deemed unnecessary”!

By this point, doubled over in pain, my friend broke down in tears when on the phone with insurance company.  Because it was obvious that the patient was in  critical pain and distress they were directed to present themselves to the emergency room.

And it was through the ER my loved one was taken to the operating room where they found that there were so many large fibroids, and benign tumors that they literally were stacked up behind one another so that ultrasounds could not pick them all up!  In addition, they had begun to attach themselves to the ligaments which is why standing erect was becoming prohibitive.

Yet it would take the surgeon several weeks of pushing, prodding and documenting the necessity before the insurance company came around to the notion that this indeed was “medically necessary” and paid the bill.

I write all this for several reasons:

• Todays insurance is not about the patient but about the coverage.
• Todays health care system is not always about patient care but getting through the high volume of patients needing care.
• Todays doctor’s can sometimes lose sight of the patient; trying to balance patient care with the volume of patients, and the insurance dictating what will be covered.

So what is a person to do?

• Know what your insurance will and will not cover. And if you have questions seek the answers and keep seeking the answers until your truly understand the situation.
• If your doctor is not helping you – find another one that will. There are good doctors and health care professionals out there who truly have a heart to care for patients. But if yours is not one of them, don’t hesitate to get a second opinion.  Your life may depend on it.
• Whenever there is a procedure, radiology studies, tests, hospital admissions, and surgeries, take the time to write down questions to ask. The adage of the only dumb question is the question that is not asked is so true.
• Have an advocate who comes with you, stays with you and is your eyes, and ears throughout your medical care.
• Be persistent, be educated in your medical state, listen and think about how you feel, how your body is functioning and persevere!
• If denied coverage seek to speak to a medical liaison within the insurance company. Push your way up the ladder if necessary.  Document everything including date of conversation and the person you spoke to.
• Contact you doctor and ask them to set up a conversation with the medical liaison to discuss your case.

God bless the doctor who finally listened to my loved one and went to work to provide the best care they could possibly deliver to her patient.  I cannot imagine how difficult it is for a doctor to take the Hippocratic Oath “to do no harm” and work within the health insurance practices of today.  May God bless those in the medical arena who have the heart and desire to help.  They need our prayers.

My dear loved one recovered and was working from home on day four after the surgery and back to fulltime work in a week!  That’s one incredible spirit and I do not know how they survived as long as they did.  But I tell this story in hopes it will help others know how to navigate the often treacherous, dangerous medical arena that exists today.

May God bless the doctors who still take the Hippocratic Oath seriously despite the hindrances of our currently health care system.

And God Bless my dear friend for allowing me to share her story.  May she live a life filled with health and happiness.

 

Thank you for reading my post.  If you have found it encouraging please consider liking, commenting or sharing it.  Feel free to even re-blog – may these words take flight!

I have additional insights I’d love to share with you found in the pages of my debut book: Surviving Medical Mayhem – Laughing When It Hurts.  To order a copy or learn more go to my website at www.lorettaschoen.com

 

Blessings for Health & Wellness.