Alicia
(continued from home page)
insurance companies, and now that I need something back, it is
one brick wall after another.
[Alicia generously shares her story here, but asks that we
not use her last name.]
Health Care for All is not just about providing for the uninsured;
it is also about protecting people who are supposed to be insured
and are nonetheless denied the care they need. It’s about
allowing doctors who have actually examined a patient to make decisions
about their care. It’s about cutting through layers of company
bureaucracy that make government administrators look like rank
amateurs.
Recently, I have been through a nightmare encompassing all of
the above.
Last July, my husband became very ill. After 11 days in the hospital,
he was sent home with a walker and a wheelchair.
For a while it looked as though he was improving.
I continued to work at my job in advertising sales, not only
for the income but to keep insurance. I would prepare food and
put all his necessities where they would be handy before leaving
for the day. We paid for a rolling walker with a basket to give
him more independence. Our health coverage did not include in-home
care, so we did the best we could.
Then his condition worsened, and it became impossible for him
to stand or move himself from chair to bed. I tried numerous ways
to get help for at least part of the day. As much as friends might
want to assist, there is only so much time they can give, and as
his health deteriorated, we had to pay for professional help.
This was extremely expensive, but I could not give up my job and
lose our insurance. I began to dip into our retirement savings
and made plans to sell my car. We could still only afford part-time
help. The rest was up to me.
I had suffered a severe back injury years before, and many things
I was doing were damaging to my back. At the same time my arthritis
was progressing rapidly. But what choice did I have? There was
a lot of lifting -- not the least of which was getting the wheelchair
into the car trunk for doctor visits. There was little sleep. Needless
to say, there was no time to see to my own health.
In January, I lost my husband. He was my best friend and love
of my life.
I tried very hard to go on and pull myself together, but finally,
the physical and emotional pain proved to be too much and on the
advice of my doctor, I applied for temporary disability. Not surprisingly,
I was terminated the next day. I immediately filled out forms and
remitted payment for my first month of COBRA coverage.
COBRA was enacted to allow an insured worker to buy up to 18 months
of paid coverage when leaving a job. I needed to sign up, because
even missing a short period of coverage can make someone uninsurable,
and I had immediate health-care needs. At $447 a month, COBRA was
still far cheaper than anything else I could get; what’s
more it is unlikely that I could get individual insurance at any
price due to pre-existing conditions. So I was grateful to have
this option.
I discovered that I now had three layers
of bureaucracy to deal with: There was the COBRA administrator,
Ceridian (the 1st layer) – which
I credit for doing its job promptly and reporting payment and eligibility
to my insurer, Cigna Health Care (the 2nd layer). In most cases,
Cigna does not pay directly but contracts with Sutter Gould (the
3rd layer
I needed to see a rheumatologist, but my primary-care doctor was
required to get permission for the referral from Sutter Gould,
where it is up to a clerk to decide whether I can see a rheumatologist,
which rheumatologist I can see, and what he or she can discuss
with me and treat me for.
My doctor’s office started the procedure to get the referral
from Sutter Gould. Lo and behold, Cigna told Sutter Gould I was
not covered. I called Cigna and was told that they had no record
that I had paid for COBRA. I called Ceridian, which assured me
that indeed that information had been sent.
I called Cigna back. The representative had no knowledge of COBRA,
and I spent an interminable amount of time trying to explain it;
finally the rep agreed to call Ceridian and got confirmation that
I had indeed paid my premium. She then informed me that they still
needed that information in electronic form before they could enter
it into the system. I called Ceridian again. Ceridian assured me
that the information had been sent electronically and
that they would send an urgent request to Cigna to please make
sure it was uploaded into their system.
I called my doctor’s office and assured them the problem
had been resolved.
The doctor’s assistant called Sutter Gould. Sutter Gould
called Cigna. Sorry, no coverage! And the cycle started again.
This went on daily for most of a month. I have 17 documented calls
to Cigna. Ceridian made 3 urgent requests. After the seventeenth
call to Cigna, I went on line and found the name of the CEO and
the home-office address and phone number in Philadelphia.
I spoke to the CEO’s assistant and was put
through to a customer advocate. No one during all my calling had
ever allowed me to talk to a supervisor, much less informed me
about such an advocate. This wonderful woman went to work for me
and got the problem resolved. She called me back the same day to
tell me the problem had been with their system and it would now
be corrected immediately! It was. I finally was allowed to speak
directly to someone at Sutter Gould and tried to tell her that
they could go through with the referral. No, said the rep. They
had already tried three times in the past. Why wouldn’t I just accept the fact
that I had no coverage?
Fortunately, the Cigna advocate took it from there. After 31 days,
my doctor’s office was able to start the referral process.
A few days later I received written permission to make an appointment.
At last, I called the rheumatologist’s office to make my
appointment, but no, they said, I could not make my own appointment.
The appointment must be made by my primary care physician’s
office. So I called my doctor’s office once more, leaving
a message that they had to make the appointment. My doctor’s
assistant called me back promptly with the time and date and informed
me that I could make changes directly if needed.
Unfortunately, the first available appointment was three months
hence. I still have three weeks to go before I will see this doctor.
In the meantime the problem has worsened considerably.
I sure hope it’s worth it once I finally get there. |
