Wednesday, August 7, 2013

Medicare Advantage Plans, Medicare, The Government, SCREWING THE SICK PEOPLE OVER!

 I CANNOT even begin to say just how UPSET, READY TO THROW IN THE TOWEL, FORGET ALL OF THIS CRAP ENTIRE MESS!!! I THOUGHT I had REACHED MY LIMIT last week, but YESTERDAY TAKES THE CAKE FOR ME!!!! My Pain specialist feels I NEED a Epidural Steroid Injection. He thinks we MAY see me get RELIEF from this INTRACTABLE PAIN I have been in again for for more WEEKS!!!! So, I go in last Friday for the "formality" of an office visit so he can get the "approval" through Humana for the procedure. Well, I had not heard by yesterday and I knew he wanted to do this injection ASAP, which means FRIDAY this week when he does his procedures! I call them, and the woman that does all of that said they "submitted" the forms, and are talking back and forth to Humana about this. So, in other words, sounds like my doctors office is doing their job. But, since that have not gotten AN APPROVAL, I told her I WOULD CALL also to see if I could help rush things up a little. If I don't get it approved by TODAY (Wed.) then I won't be put on the schedule and will have to wait until a WEEK FROM FRIDAY to be in pain!!!! So I call Humana. I get the same old run a round, sent her, sent there, need to talk to "prior" authorizations, which is where I was supposed to be anyway. I get another woman in "Prior" Authorizations, that tells me, well, I need to send you over to our "Pain Prior Authorization 3RD PARTY UNIT!!!) Now I am trying in my mind to decide what the hell that is! I knew Humana had done some things with "pain management" but SUPPOSEDLY TO HELP PATIENTS! BULL SHI^%!! I get there, not knowing "who" I am talking to. And some snot nosed girl, who had not a compassionate bone in her body tells me, "Well, your authorization was received last Friday. Okay and.... WE "denied" it yesterday"!!!! WHAT! My doctor said nothing!!! THEN I ASK WHY??!!! By this time I am almost hysterical. I am standing here in more pain than I can even describe. I just got through with a dental appt I could NOT afford and I still am so hoarse I can barely speak, and trying to get well enough to even go to the dentist and have the injection, and here this woman is telling me THIS.... "Well, YOU have an IMPLANTED PAIN PUMP, thus YOU DO NOT NEED INJECTIONS for PAIN! YOU HAVE PAIN CONTROL!!! Now, by this time, I am ready to throw the phone across the room, I am so hoarse I cannot utter ONE word to this insanity, and then she begins her "speech" about APPEAL!!! HELL APPEAL??? I DO NOT HAVE WEEKS!!! to get these INJECTIONS! And what the hell does me having a pain pump due with my back possibly having compressed nerves and inflammation, bone spurs etc in it??? So, JUST AS I SAID THIS PAST WEEK, NOW it is where it it a POLITICAL GAME with PATIENTS LIVES! I finally did enough research to find this "3RD PARTY" that does Humana's "pain management". They are ORTHO-NET!!! BELIEVE ME HUMANA had that information BURIED!!! I had to do some digging to find all of this out, but they have some "outside" agency, that is nothing but a bunch of "pencil" pushers, how have NO CLUE and DO NOT CARE ABOUT WHETHER I DIE OR LIVE!!! That is the truth! These people are getting Humana A DOLLAR OR TWO "SAVED", yes saved all right, while WE AS PATIENTS have to SUFFER THROUGH THEIR PENNY PINCHING GREED!! THIS is also part of 'OBAMA CARE"!!! THIS is WHY I was saying about the PETITION, WE HAVE GOT TO STOP THIS AT CONGRESS!!! Between all of the bickering and sitting and DOING NOTHING! THEY HAVE SCREWED US FOR SURE!!! I cannot say just how upset I am! As you can see I only slept about 3 hours and there is no way I can CONTINUE TO LIVE LIKE THIS!!! My "pain pump" is NOT for ACUTE pain, or NEW PAIN like a compression fracture. It is like denying to give you blood pressure medication one day since your blood pressure seems to look normal. Or telling a diabetic, well right now your blood sugar is good, so you do NOT need insulin!!! Or saying, okay well, you only have 2 gallstones, so YOU can HANG on until there are more!! I know it sounds insane, but THINK OF ALL THE WAYS this EFFECTS NOT JUST ME BUT YOU!!! I AM BEYOND the place of GIVING UP!!! I am way PAST THE TEARS, THE BEING PISSED, ETC.... I am just going to sit on my sofa, AND WITHER AWAY IN PAIN...NO MORE... I CANNOT TAKE NOT ONE MORE DAY OR ONE MORE PERSON WHO DOES NOT KNOW ME, telling me oh, you are all right you have a "pain pump"... I have had it.... THEY HAVE WON!!!!

 THIS is MY LETTER below to the President, the Senate, the House, The Head over Human Services, and anyone else that will read, including the Humana insurance bunch. 


Well as someone who has suffered way more than I should ever have to, I am here to say, that any more "cuts", any more "changes to codes" or more "prior authorizations, or NOT paying the GOOD DOCTORS, so they STOP SEEING MEDICARE PATIENTS (ie especially MEDICARE ADVANTAGE PAYMENTS), will have the entire NATION SEEING PEOPLE IN THE STREETS, writhing in pain, and ready to just say FINE WE GIVE UP! Forget OUR "quality" of life! Forget YOUR CITIZENS being ABLE TO LIVE NORMAL LIVES! This is bringing our doctors and us as patients to OUR KNEES, taking away WHAT IS LIFE SAVING for MANY OF US! I have endured MORE PAIN in my life than ANYONE should have to! I have chronic illnesses that CAUSE PAIN! Lupus, Rheumatoid Arthritis, Degenerative Joint and DISC disease, 2, yes TWO Heart attacks (one due to pain possibly), Multiple Joint REPLACEMENTS, Kidney stones, migraines, Peripheral Neuropathy, Osteoporosis (which is SEVERE) and possibly causing my spine in places to have compression fractures, CHRONIC DOUBLE vision, tarsus tunnel, both of my THUMBS are WORN and Degenerated so badly they need replacement, like I ALREADY have in both KNEES and a RIGHT SHOULDER, now developing HIP pain, Lower back pain, stiffness, swelling, and my CERVICAL SPINE just had 4 LEVEL REPLACEMENT because it was so badly degenerated. ! I could GO ON! There is more. To Think, about 10 YEARS AGO, I was  "NORMAL, working Mom, Wife and Daughter. I have had health issues ALL my LIFE, but when the LUPUS AND RA decided to "knock on my Door", MY ENTIRE LIFE changed overnight! I went from working, to have to completely stop. All of the heart issues, the joint issues, the ongoing migraines, and all of the "symptoms" that were going along due to "Lupus and RA" were taking their toll. I did NOT get DIAGNOSED until 10 YEARS ago with WHY my body was falling apart! I had my FIRST HEART ATTACK at the AGE 40! AND I am an avid exerciser daily, I eat extremely healthy, I watch every pound, I am the weight I am supposed to be, I Do NOT drink, I do not party, I DO NOT do any of the things that would be a factor in my "health problems". I was a 5 MILE A DAY WALKER, for years and years! I rarely eat "beef, pork, etc", and eat salads, veggies, fruits, fish, chicken, and stay away from fat, carbs, and high calories. So, thus the surprise when I woke up alone 20 miles away from any hospital or even ambulance for that matter, and DROVE MYSELF to the ER that morning! Good thing I did! That was only about 6 weeks before the day I turned 41!!!! As I began to have more and more pain, stiffness, fatigue, unexplained joint issues that called for surgery, blood abnormalities, more and more PAIN, that even was so bad, my doctor had to IMPLANT A PAIN PUMP so I can have enough relief. There is NO WAY to control MY pain without it! IT is totally intractable! But, this PUMP does NOT RID ME of ALL PAIN! If something "breaks", like a hip deteriorate, or I have a compression fracture of the spine due to the osteoporosis, the "Pump" does NOT completely relief that type of pain. In fact it is NOT relief but SOME of the pain! It gives ME BACK, a TOLERABLE LEVEL so I can have some QUALITY OF LIFE! WITHOUT IT, or with more ACUTE PAIN, then I am completely WITHOUT an NORMAL LIFE! I would be confined to a bed or sofa, and not be able to to anything, but probably scream in INTRACTABLE PAIN! There are reasons for pain, that even our doctors DO NOT KNOW YET!  So, now you have a little background of just me, and I see hundreds, thousands, like me that have the same issues, some even worse than myself! They are dealing with exactly what I am. My "Medicare Advantage Plan" HAD been OKAY! UNTIL JANUARY 1ST 2014!!! When the “government” decided to take MEDICARE, then PICK AND CHOOSE,  some of the CHANGES from "Obamacare", it totally put US on the WRONG SIDE of the table! Since January 1, 2013, I have FOUGHT to get every CLAIM PAID, due to this "NEW SYSTEM" that costs thousands of dollars at the doctors and hospitals. It is such a MESS, EVERY claim myself or my Mom (she is 80 and bless her heart, she takes care of me rather than how it should be ME helping HER!) I have to FIGHT the doctors, the hospitals, the entire medical scene, along with my MEDICARE ADVANTAGE PLAN! I have DOCTORS telling me I had better FIND SOMEONE ELSE, because THEY ARE GOING TO QUIT TAKING these PLANS and that they may not be able to even AFFORD TO SEE MEDICARE patients NEXT YEAR (2014)!!! These are experienced, well trained, incredible physicians that have "HELD" my body together, with their care! If If were no for them, I probably would NOT be here today. I almost died in 2010! Due to the Lupus and many complications, along with my 2ND HEART ATTACK while in the HOSPITAL, I almost died! Now (as of (July/August 2013) I NEED a special EPIDURAL LUMBAR INJECTION in my spine! I have once again ACUTELY began to have INTRACTABLE PAIN in my LOWER BACK, MY HIPS down into both FEET!!!  It feels like someone is pouring HOT LAVA right DOWN my INNER BONES in both legs, from just above my HIPS down to the BOTTOMS of my FEET! I have been "ENDURING" this for WEEKS, and the doctors are doing all they can to FIND the problem and FIX IT! NO PAIN PUMP will STOP ACUTE PAIN or pain from something "broken" that needs to be repaired! IT is for chronic, long term pain. But it will NOT get rid of acute swelling, a compressed nerve, a worn out joint, and so forth! LAST WEEK, my Pain Specialist Physician (who already has the CT, the EMG the NCS) and "tests' to show nerve issues, damage and deterioration to my lumbar spine in which I NEED an INJECTION to first of all SEE IF it WILL HELP with swelling, inflammation and pain! Plus it can tell HIM MORE about what HE needs to do, to FIX THE PROBLEM! His staff as always send the proper RED TAPE PAPERWORK, into my (Medicare Advantage Plan for “APPROVAL”. Well, they DENIED the AUTHORIZATION!!! How CRAZY is that!!! NOW due to all the CHANGES I in these ADVANTAGE plans and MEDICARE, my MAP went to a "3RD PARTY" who does THEIR PAIN PAPERWORK! Which by the way NO ONE told myself or anyone I know about this "change" in how our claims are processed! So, this "3rd party" said "DUE to me having a PAIN PUMP" implanted”I did NOT NEED the INJECTIONS!!! That is total insanity! Who is there, working on pain patients authorizations and claims??? They are KNOW NOTHING about PAIN MANAGEMENT. IF they did, then they would KNOW ONE does NOT have A THING TO DO with the other!!!??? Just because I have a "pain medication pump" doe NOT mean it will just TAKE EVERY PAIN AWAY! If my hip, back, thumbs, feet, are 'damaged" and "worn" that type of pain has to be "fixed" in order for relief! If a NERVE is COMPRESSED, NO AMOUNT of PAIN medication will "release" and relieve pain from that NERVE!! That is like telling a diabetic, well your blood sugar is good today, we are NOT giving you any INSULIN!!! OR someone has a CAVITY and it is in the NERVE, and telling them WELL the PAIN PUMP will HANDLE IT, so we can't do anything but let you KEEP THE TOOTH! I APOLOGIZE for all of the “Capitalization!” I just cannot even find the words to describe what I am enduring now. You are NOT AWARE of the PAST 5 WEEKS of what I have and still am ENDURING!! I am in CONSTANT, INTRACTABLE PAIN! I have NO QUALITY OF LIFE! I CANNOT enjoy my Summer, my yard, I cannot clean my home, cook, or go to the store by myself. I cannot even go to my doctors myself, my husband has to totally take care of me! I barely move off the sofa for the most part, because due to pain, stiffness, swelling and NOW I have a SEVERE LUPUS FLARE and also the RA is acting up, that the fatigue, the face rash, all of the horrible symptoms of Lupus are here due to me having to endure so much pain. I cannot SLEEP, I cannot sit long, stand long, walk long... My life has TOTALLY been TAKEN OVER due to possible more damage in my LUMBAR SPINE, HIPS, THUMBS AND FEET DUE TO the Lupus and RA!!! Some of those things may have to be “fixed”, for that type of PAIN to be relieved! THIS is not ONLY EFFECTING me! IT it taking its TOLL on my SPOUSE, my MOM (who I am supposed to be helping out), my 2 children, and all of those that love and care for me. They are worried out of their minds! My husband is having to try and "juggle" everything I can't do now within his own work as a Web Developer, Designer, Database consultant and so forth, so his clients are taken care of, while HE ALSO TRIES to take care of ME! I know beyond a shadow of a doubt I am NOT the ONLY one out there. I see it day after day, week after week, those like myself that are having the exact same issues, if not worse than myself! While you sit in Washington, rather than "taking care of your citizens", bickering, cutting, chopping up bills to "suit"  needs, YOU are “PLAYING POLITICS” with OUR HEALTH! WE, as those who VOTED you in, fully expect to be TAKEN CARE OF (Medicare is our money we invested for our older lives), NOT thrown "under the bus" and left to fall to pieces on the street! Why can you get your act together, quit bickering, stop putting other things in front of what is important to us, your constituents, and give SOME thought to how YOU would feel if this were YOUR MOM, YOU, or a loved one or friend? Would YOU rather some "pencil" pusher try to "save a buck" for an insurance company that is rich among the rich, as YOU or someone YOU LOVE is in INTRACTABLE PAIN, being told NO, you have this, that or the other, so NO, we do NOT think you NEED THIS! WHEN did IT GET, that the GOVERNMENT can TELL our DOCTORS what PATIENTS NEED??? I see it all the time... now medications, tests and so forth, our DOCTORS say WE NEED them. They have documentation to prove it! Yet, some STRANGER, that KNOWS NOTHING about ME, can just OVER RULE MY DOCTOR, and say NO, that patient does not need this!!! Again, how would you feel if it were you right now??? Or someone you love very much!!! I can bet YOU would be doing ALL YOU could to get SOMETHING DONE to HELP them!!! Now, I am NOT talking about doctors that are NOT legitimate, and do tests, etc.. for kickbacks etc. THOSE are NOT doctors to me, they are like vultures who need to be taken out of our system. They are ruining it for our GOOD physicians!!!!

I want to “THANK everyone” that “takes the TIME” to really READ this letter! It is extremely not only “critical” to my situation, I speak for MANY others out there, as also myself. As I said I hear it, I see it everyday from other patients, thus it is imperative that the system of Medicare, Health Care and Insurance are FIXED for us, as people, humans, flesh and blood. I would never wish this kind of pain on anyone at all, not even someone I did not really like… no one should ever have to go through this.



Post a Comment