The Affordable Care Act (aka Obamacare) certainly isnt our countrys only health-insurance conundrum. We recently learned that the hard way.
For instance, Husband Richard and I still dont know if the health insurance provided by my employer is going to pay for the $3,500-a-week residential therapy clinic to which he was sent following emergency treatment for a moderate stroke.
I contribute about $200 per biweekly paycheck toward that policy.
On Dec. 28, Husband Richards understandable post-holiday exhaustion became an emergency when his speech slurred and his legs couldnt support his own weight.
At the hospital, doctors said words you never want to hear: Your husband has had a stroke.
So far, weve been very lucky. His mind remains intact and, while his speech and control of the right side of his body are impaired, he can talk, hold a pen, button a shirt and walk, albeit haltingly.
Those glorious accomplishments dont diminish the seriousness of the losses he has suffered and the permanent changes to our lives nor the hard work it will take to get him back to where he was before, or as close to it as possible. And none of this comes with guarantees.
After a few days in hospital, with me sleeping on a cot at the end of his bed, Husband Richard was to be transferred to San Luis Transitional Care, an in-patient therapy clinic many friends proclaimed to be wonderful.
But that clinic and our insurance company dont have the in network relationship that would have allowed the latter to fully pay for the services. And we were told that because our group policy is considered the primary insurer, Medicare wouldnt fill in the blanks.
If Medicare had been the primary, or only, policy, it supposedly would cover 100 percent of the dauntingly high expenses. Arrrrggggh!
On New Years Eve, we learned the insurance company has an in network arrangement with another San Luis Obispo facility. So, Husband Richard was discharged from the hospital, and we trekked over to that clinic.
About 4:30 p.m., I wheeled him into the building, and then immediately wheeled him right back out again.
The clinic is being extensively renovated and, while we applaud the upgrade, Husband Richard is violently allergic to most construction fumes, such as those from paint, shellac and glues used to adhere flooring and wallboard. If hed stayed, hed have had pneumonia within hours.
Desperate, we called the hospital, and we were told he could not go back. The case was closed.
With dark approaching and no other obvious options, we took him home. Were we nuts? It was a tumultuous night. Son Brian and I were unprepared and terrified. We made mistakes. Fortunately, he survived them and so did we. He didnt fall or choke, and we managed to provide basic care for his battered body and mind. But there was so much we (and he) didnt know.
Nobody got much sleep that night.
In desperation, at 8 a.m. on New Years Day, I called San Luis Transitional. Even on the holiday, they were there! Connie Burmaster and Teresa Berning found space for him, and we checked him in right after lunch.
Hes been there since.
The next day, I told our insurance companys case manager that the in-network clinic had been medically impossible. She said that, with no other options within 25 miles of our Cambria home, they probably could establish a one-time contract for in-network status.
The operative word is probably.
Our friends were right. San Luis Transitional a former elite recovery retreat for upper-crust plastic-surgery patients is upbeat and very professional. The staff is unbelievably perky, optimistic and skilled.
However, as I write this nearly two weeks into January, financial negotiations between the clinic and insurance company continue as Husband Richard works his way through hour after hour of expensive rehab with skilled therapists hes affectionately dubbed as his gentle slave drivers.
Because of quirks in the contract, we still dont know for sure if the insurance company to which Ive paid thousands of dollars in premiums over the years actually is going to pay for the critical care Ive always believed would unquestionably be covered.
And, quite frankly, in these circumstances, that really isnt something we should have to be worrying about.
What we learned about strokes
- Someone whos experiencing a stroke may not exhibit classic symptoms. My husband aced the FAST test (see below) but was having a stroke. He joked with paramedics and emergency room personnel but couldnt walk or use his right hand effectively.
- Strokes can produce some unusual results: His sense of taste and hearing are more sensitive now. Hot coffee, spices and flavorings he loved before now cause pain. Moderately loud noise now hurts his profoundly deaf, hearing-aid enhanced ears.
- Doctors tell us panic attacks and depression hes dealing with are common side effects from damage to the brain. So are headaches, as the brain creates new pathways for information.
- Many things that used to happen automatically dont anymore. He wears out very quickly when he must think carefully about every step he makes, every word he says and how to get that spoon from the bowl to his mouth and then how to swallow the contents of the spoon.
- Patience is key. Two steps forward, one back. (Neither of us is very patient.)
FAST is an acronym for face, arm, speech, time. If you suspect someone is having a stroke, see if the patients FACE droops or the smile is uneven or lopsided, if an ARM is numb, weak or uncontrollable, if SPEECH is slurred and theres difficulty speaking or understanding. TIME? If any of these symptoms are present, call 911 immediately.
But also go with your instincts: My husband could raise his arms above his head, stick out his tongue and wiggle it, respond to commands, count backwards from 50, repeat a complex sentence and tell me what year it was. I called 911 anyway, and later learned he had indeed had a stroke.