The Affordable Care Act (aka Obamacare) certainly isn’t our country’s only health-insurance conundrum. We recently learned that the hard way.
For instance, Husband Richard and I still don’t 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 Richard’s understandable post-holiday exhaustion became an emergency when his speech slurred and his legs couldn’t support his own weight.
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At the hospital, doctors said words you never want to hear: “Your husband has had a stroke.”
So far, we’ve 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 don’t 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 don’t 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 wouldn’t 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 Year’s 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 he’d stayed, he’d 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 didn’t fall or choke, and we managed to provide basic care for his battered body and mind. But there was so much we (and he) didn’t know.
Nobody got much sleep that night.
In desperation, at 8 a.m. on New Year’s 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.
He’s been there since.
The next day, I told our insurance company’s 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 he’s affectionately dubbed as his “gentle slave drivers.”
Because of quirks in the contract, we still don’t know for sure if the insurance company to which I’ve paid thousands of dollars in premiums over the years actually is going to pay for the critical care I’ve always believed would unquestionably be covered.
And, quite frankly, in these circumstances, that really isn’t something we should have to be worrying about.
What we learned about strokes
FAST is an acronym for “face, arm, speech, time.” If you suspect someone is having a stroke, see if the patient’s FACE droops or the smile is uneven or lopsided, if an ARM is numb, weak or uncontrollable, if SPEECH is slurred and there’s 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.