Thursday, July 26, 2012

Fighting an Up Hill Battle

Wondering what's going on with me lately? I'm fighting the insurance company and bureaucracy. While Obama's health care bill passed the Supreme Court, I'm still arguing back and forth with my provider. I don't intend on getting political here.

I've been on a variety of drugs for the muscle spasms in my right arm and leg since my stroke two months ago. In high enough doses they leave me spasm free, but a zombie. I can't do my therapy as a zombie. In lower doses which allows me to do my therapy, it just doesn't work. The muscles are so tight with spasms the muscles won't move. Imagine a charlie horse type spasm from your big toe to your hip or from your finger tips to your shoulder every three to six hours and you get the picture. Or misfiring signals from the brain to muscles where all they do is tremble. Because of the Clonus (tremors) in my ankle, my whole leg will shake from 30 seconds to three minutes when I'm trying to walk, sitting at my desk, or sleeping. This is just irritating not painful. But imagine it happens up to thirty times a day.

But I digress. My fight with the insurance company deals with the next level of treating these spasms...Botox injections. The insurance refuses to cover them. This isn't an experimental treatment. It has been used for years in Parkinson's, MS, Cerebral Palsy, and muscle spasms.Shots of Botulism are injected into the muscles to relax them. They are expensive at $365 per shot but if it will possibly allows me to lead a productive life of an author, minister,and a human being. It's worth it. I'm not a movie star or someone insecure about their looks. This isn't cosmetic it's a need! It will get me out of pain and restore function. It will allow me to work the weak muscles until they no longer spasm.

The insurance bills tallied for my month in hospital is $42,000. With adaptive equipment and transportation such as a toilet seat, braces, shower chair, walker and other incidentals, the total bill was $54,000 which they had no problem in paying in full with $1,000 coming out of my pocket per my PPO. Thank God for royalty checks.

The difference is recovery versus adaptation. They will gladly pay for anything which will substitute use rather than recover use of whatever is wrong. Those that know me, know I don't back down from a righteous fight even when I'm the underdog. I'll continue to my last breath!

Am I wrong to want to recover the use of my arm and leg to almost pre-stroke condition? Now that I'm post 30 days into my recovery and it takes longer, but is achievable.

Am I wrong to want to not be in pain? I will say they will pay for any pain relief drugs.

Am I wrong for wanting to work again? I'm too young for medicare and make too much money in our household for medicaid. That's taking into consideration for a monthly out of pocket pharmacy bill of $700.


I have applied for disability. I'm a realist. For my husband with bad lungs, bad heart, and cancer at age 55 it took four years and a court case to get approved! We almost filed for bankruptcy and lost our house because of that delay..

What is wrong with this picture?

2 comments:

Zan Marie said...

Go, Jo, Go! Fight, Jo, Fight! I'll be cheering you on.

I just finished a editing a memoir for a TBI survivor who sustained major disability. She had to fight insurance over little things even, like her signature changing over time while she recovered. It's ridiculous.

J.L. Murphey said...

Yeah, I went to my bank about just that issue last week. Now I'm signing left handed and it doesn't look anything like my signature. I did a new signature card. About the insurance, I shouldn't have to fight for something I pay for.