Wednesday, May 25, 2011

Artificial deadline

6:48 p.m. Today's project was to make arrangements for a new C-Pap machine to be delivered here for Steve. He has been diagnosed with sleep apnea, and has been successfully using the machine and its mask and tube components for several months now.

With his breathing normalized through the night and the current machine performing wonderfully, why a need for a new one? This is the bureaucratic nightmare that began when he qualified for Medicare!

The first thing I did was remove Steve from my school district health plan, saving quite a sum each month. So far, so good. Then I needed to find an HMO provider that was contracted with Medicare here in Riverside County. I selected CareMore, because of their high customer satisfaction rating. We had some trouble getting them to understand that I speak for Steve because of his Alzheimer's condition, so I faxed over our signed Power of Attorney, the one accepted by our banks and our life insurance companies. However, the CareMore people have their own "Five Wishes " several-page form that I had to have witnessed (but not notarized) by two friends at church. Well, we got that done.

Next came the selection of a primary care doctor and neurologist. To our dismay, neither of his doctors was in his new HMO's network. We selected two doctors whom I was familiar with mainly through charitable activities their wives had participated with me in town, and felt at least satisfied that they were of sound reputation and experience. The Lord helped me through this maze, but the stress was just beginning!

We have to trust in God's word and will, because God is not the author of confusion, as we read in I Corinthians 14:33. Nevertheless, a great deal of confusion exists in this world. Especially in the world of medical providers, as I was soon to discover.

Despite the fact that Steve has always had regular appointments with our primary care physician and his neurologist, he was required to have a complete physical at the HMO's facility. All of his systems were fine, just as they'd been at a recent appointment with our Dr. Guzman. We then found out that the doctor we'd selected was not accepting new patients, so they found him another one whom I know nothing about. A question one might have asked is, could they have updated their provider list weekly in these days of computerized everything? Sigh.

Back to the C-Pap machine. On Friday I took a call from a breathing equipment provider (Supercare) telling me that Steve's machine had to be replaced, per CareMore, because the Apria Company, which has trained us in the machine's use and has answered all questions and even took time to help Steve with some initial confusion in putting it on, is not one of their contracted providers. I also was told to fax over proof that Steve really needed the machine, the 7-page sleep study Dr. Rai had done, and a written request from the neurologist that Steve would continue to need the C-pap! At $1.50/page, that was a financial drain I hadn't expected. But I got it done, putting my ladies' retreat funds in jeopardy.

Supercare called me yesterday with a rush-rush attitude, saying that Apria was going to come over to our house and retrieve the machine we have any day now, so could they bring theirs over? Not so fast! Never being one to take the first answer, I questioned whether the mask and oxygen tube were included in the coverage, and the gentleman said "no." Now why would I have changed Steve over to Medicare if I now would be out of pocket for equipment my private insurance used to cover? I suggested that we hold off on the delivery until that issue could be clarified.

Another issue: CareMore would only cover the first month without an okay from the primary care physician to continue. Never mind that a neurologist had prescribed it for Steve's lifetime. Steve stops breathing during the night, for Pete's sake! That's what I call an "artificial deadline."

"God won't give me more than I can bear," I loosely paraphrased I Corinthians 10:13 in my mind as I asked friends to pray on Facebook, and went into my office to finish writing the Bible study for tomorrow. Later, the HMO called and said, after a long hold time, that the mask would indeed be covered, along with the oxygen tube. Thank you, Lord.

This afternoon when I returned from giving a facial, I called Steve's new primary care physician, only to learn that she isn't open for an appointment until August! That is considerably past the HMO's 30-day deadline for doctor approval. Back with CareMore again, they were now scrambling to find me another doctor, and the issue remains up in the air. I politely reminded them that it was their 30 day deadline, and that Steve is in demonstrably excellent health, as testified by two complete physicals in the last 4 months! One has to feel sorry for the customer care folks, mainly because of the bureaucratic burdens put on them by their employer!

The main issue is this: God has blessed Steve with great health, we are getting along day by day by His grace, and when we are notified of a new doctor and timely appointment, we'll give God the glory!

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