Monday, June 19, 2017

June 19, 2017: just kvetching

This morning I called Dr Vande Zanschulbe (my surgeon) one more time.  I had already left several messages and received no reply after I heard that Aetna was booting me out of the "home." Today at noon was the deadline to appeal that decision.
I finally got a live person at the doctor's at 10 AM.  I told her my problem and she gave me his assistant, Brittany's voicemail.  At 11 AM I called again and said it was an emergency.  Brittany spoke to me for a few minutes.  Then Monica gets on and explains about insurance and therapy, etc, etc.  She must have repeated herself 10 times.  She told me that I just did not understand.  Finally I told her to please listen to me.  I was not asking for their office to get involved with Aetna.  All I wanted was the doctor to write in his progress notes what he told me during my appointment.  He told me that I needed one to two months more of supervised care.  She started up again with her same spiel about insurance.  I told her that his note was all I wanted from her, nothing more.

Monica then told me that such a note was impossible because there wasn't enough time.  I told her if someone had called me back when I started leaving messages that there would have been plenty of time.  Then she lied to me.  I just HATE being lied to.  She said that if the doctor did write a note that it would have to be transcribed, typed up and submitted and it would take a couple of weeks.  I then told her that I was holding in my hand the progress notes that he wrote during my appointment.  They were handwritten by the doctor.  Unfortunately,  I didn't know that his progress notes were in the envelope I was given as I left.

That office never did supply the progress notes, not to me and not to my case manager.  Maybe they never even mentioned my request to the doctor.  I did not receive a phone call from them.

I  realize that the odds of my appeal to Medicare only has a 10% chance of succeeding.  But without the doctor's input my odds are even lower.

Emily, the social worker at the home, told me that I could call in my appeal and that she would have until 5 PM to fax in the accompanying paperwork.  So, I called the case reviewer employed by Medicare and said I was worried about going to an apartment that hadn't been set up and was full of boxes.  I also told her that I live alone.

I just happened to have an appointment with a trauma doctor this afternoon.  I told her about my problem.  She wrote in her notes that I should stay in the "home" until the surgeon reevaluated me.  She told me to make an appointment with him for next week.  She typed up the notes herself and her office faxed it to Emily.

Maybe my appeal has a chance.  I want to stay here where I get physical and occupational therapy every day.  If I go back to my apartment, maybe I'll be allowed to have a therapist come into my home for an hour or two per week.

If I go to my apartment I will be alone most of the time.  I won't be able to take a shower because there is only a tub in the apartment.  If I fall while using a regular toilet, there will be no one to hear my screams, no call button to push, no person checking on me periodically.

Yes, I'm scared to return to an apartment that I've only spent 3 nights in.  I'm returning with a major trauma to my right hip in addition to my handicapped left leg.

It makes sense to let me get stronger in a controlled environment for at least a few more days.  I work hard at therapy.  The therapists' records of my progress can prove that.

If my efforts don't work and I'm sent home, so be it.

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