February 15, 2013

Becoming a statistic

I have been composing this post in my head for a long time, trying to figure out how to tell a story that is representative of what is happening to many people, gives some insight into some real problems in this country right now, and doesn't come off as whiny or victimized. I'm going to give it a shot, anyway.
Having spent many years obtaining a bachelor's degree in nursing, I had managed to work my way up to a comfortable life with a good job, an affordable mortgage, not too many credit bills, the usual ghastly student loans. I was single with no kids, and just entering the range that gets labelled "middle age".
I was incredibly fortunate to meet an amazing man, and without him this story would have ended much, much sooner.
Then I got sick. Tried to work when I could for quite a while, then couldn't work at all. Then misdiagnosed and given a treatment that caused permanent damage, rendering me disabled for even longer - and unable to do some things forever.
But I had short term and long term disability insurance through my employer, which paid at 60% - much better than many folks.
I continued to attempt to return to my job - a bit better than half pay is good, but to pay the bills and pay the mortgage does require the full paycheck! The problem was that the employer had loopholes that allowed them to be exempt from ADA and EEOC requirements to accommodate disabilities if they chose. So I was told that in order to return to work it had to be with no restrictions, no accommodations. So my doctor reluctantly agreed to release me on the condition that if I was unable to do the work in those circumstances then I was to come back to him and be put back on disability leave.
Which is exactly what happened. My company eventually let me go since I could not return to work without being accommodated.
And then the disability insurance company advised me that they would not pay any further, since my doctor had released me to return to work without restrictions - even though it was documented that the attempt had failed.
But....there is a process - an appeal process - so not to worry! Just file the appeal, stating the circumstances, include the medical statements, and wait.
Appeal was denied without any indication that new information provided was even reviewed. So the next level of appeal must be filed. At this point the form letters start to include the information that I have the right to legal representation in this process should I choose to hire an attorney.
This is also the time that I discovered that the ancient physician who had misdiagnosed and treated me (and who was billing me for $8K for the privilege) was for all practical purposes immune to malpractice litigation since he was careful not to carry malpractice insurance and keep all his assets creatively shielded from potential seizure. Essentially, nobody in the state would sue him on contingency.
I also discovered that despite the EEOC telling me that I had the right to sue my employer, because of their status in the state, nobody would take that case on contingency either - especially since they retain a well known legal firm.
After telephoning a half dozen lawyer's offices with no return calls I finally spoke with a lawyer in WA state who told me the truth of why nobody was returning my calls!
At this point, the loss of my home was inevitable so we packed what we could fit, stored what we couldn't and fled to WA state.
Once there, I was fortunate to be treated at UW as a charity patient and cannot say enough good things about that system or their doctors. I got a full high tech workup including hours of testing with full reports and data that confirmed all my abilities and losses.
So Finally!! Data in hand for the insurance company I can finally get that appeal approved and get all the income that I have been living without, right?
So again, file appeal with all the new data and wait. And wait.
In the meantime have filed for disability via Social Security. Saw Social Security disability doctor who agreed that limitations are severe. Denied social security disability due to age, since apparently if you qualify to work as a doorstop under age 50 - then you cannot get SSDI. The fact that there are no jobs as a doorstop where you live or a way to get to a doorstop job if there was one do not factor into the decision. If a doorstop job exists in the US, then you cannot get SSDI.
So ok - depressing, but the long term disability insurance should be coming through. I meet all the qualifications they specify, my doctors have documented this multiple times, just keep jumping through the hoops and the process will finally kick out your money, right?
Denied.
But wait! You can still appeal one more time!!
By this time, am living in OR and nowhere near UW. So I filed the appeal with only a little hope that they would actually look at all the medical records they had been sent documenting all the visits and testing that has been done to this point.
During this time I finally found a lawyer online who advertises they specialize in disability cases and have whole videos dedicated to the company that my insurance is through - so I contacted them and was finally talking to a lawyer who was willing to at least look at my case.
After my final appeal was denied, I filled out all the paperwork for the lawyer and he spent some time looking at my records.
The verdict - probably could have done something if he had been hired during the appeals process, but the ERISA laws (the only legal option I had to go after the insurance company at this point) are such that he could not feasibly win my case now.
So why tell all this? Who cares besides my mother?
This is to say: This could be you. This could be your sister, your wife, your son, your cousin, your best friend.
The road from comfortable middle class to poverty is paved in bureaucracy and medical bills.
And exercising, not smoking, going to church, eating vegetables will not protect you from a potential disaster.
So look at your current situation and ask yourself "what if I got sick and couldn't work?". You are insured against death, but most of us are not protected against losing our entire lives if we get sick.
And also, when you see that person sitting at the state office waiting for their food stamps, or at the low cost medical clinic, or pushing a shopping cart on the street - don't assume you know.
We all have ideas about what needs to be done to address the many issues that contribute to what happened to me, what happens to lots of people.
What I see when I look back is that all the safeguards that were supposed to be in place to prevent abuse and protect people had so may loopholes and "outs" that they were laughable. Again and again, doing what I was supposed to do, jumping through the hoops I was given, allowed the systems to utilize those loopholes.
Had I contacted an attorney at the start and bypassed the "system", I would likely have had a better outcome. So would the attorney.
No single individual is accountable in any of the above examples either (besides my doctor, who was frankly dotty). Responsibility is diffused and deflected, allowing really noxious things to be done to individuals without any single person being responsible.
So, after two years without an income - trying to get back on my feet (literally)- I am looking forward to what is next. And not just what is next for me. What can I take away from this horrid personal experience that might prevent it from happening to someone else?
We shall see - first step is just talking about it!

4 comments:

StacySix said...

Your friends care very much. If there's anything I can do to help or to put my talents to work for you, you have but to ask.

Edward Pearse said...

Wow. I hear all sorts of stories about the American health and insurance system and how bad it is but it really takes something like this to bring it home. The real kicker being that I'm sure the Doc who charged you the $8K for the misdiagnosis still wants to get paid even though he screwed you over.

I hope you find some sort of redress. Positive thoughts going your way in the hope that you find a lawyer willing to sue them into oblivion or a nice lotto win.

*hugs*

Anonymous said...

So sad to read this. Went through this hell myself. Almost fell in the trap the insurance company lays for the disabled--they send forms -- you think if you fill them out and make a solid case they will read them and do so in "good faith".

ERISA disability is as far as you can get from "good faith". There is virtually Nothing that can done to the ins co if they screw you over. Maybe they have to pay back pay -- sure big deal ---there is no damages ---no fines.

And US Supreme Court Justice Ginsburg ruled that one's own doctor's opinion carries no more weight than a hired ins co hack doctor who maybe never saw the patient.. (So don 't tell me the left liberal side of things is pro the little guy)

I fought them with a lawyer --took many attempts to find one-- lost almost half the income for the many many years it took to get reinstated --had to pay for my consultants , court costs and then the percent to the lawyer. I don't touch a thing having to do with that ins co now without her slapping a cover letter on it.

And when the back pay came in a lump - it-shoved me in a higher tax bracket . Everyone made money on my pain. I paid the premium for this coverage---disgusting.

When you are down there is a whole industry waiting to kick you more for * their * car payments, golf junkets and fancy offices.

I wish you well. The system isn't fixable --don't let it get you down more.

Fogwoman Gray said...

Thanks for the comments!! The purpose of the post is to add more (yes, ancedotal) data and discussion on the subject. This affects many people, and I disagree that the system isn't fixable.
It can be scrapped, modified, replaced - whatever We The People collectively decide must be done. But it will require a really large effort from a lot of people. Bureaucracies are monolithic and moving them takes a LOT of effort :D