One error would lead to finding out that my medical insurance company knew about it. And, was willing to allow me to live suffering in my own excrement...
Taking it all and putting it on the line, I knew that it would mean one of two things....
Living as I had for over two months prior to 12/07 in my own human waste... As I could not use my wheelchair, one kindly donated to me... As on 09/07 I had become 100% disabled, and I was searching local Durable Medical Equipment resellers for a wheelchair with the script I had from my Dr...
After locating the best wheelchair system and me being a newbie to needing a full time wheelchair, and my Dr's first wheeled patient. It was interesting to say the least. The other option was to make sure what ever wheelchair I needed would meet my needs.
Aetna is my medical insurance company, but this is not just an Aetna issue. It is equal in Medicare, Medicaid, and all other medical insurances. Also many other companies do these things also. I gather based on me being a layperson Aetna felt I would not, could not, no possible way discover all I did, and oddly enough I just wanted nothing more than to get my DME a K0009 wheelchair system, and try to get on with life. Now, while to society I appear disabled, I have never felt more ABLED in my entire life.
The US Medical Insurance Industry commits something far, far worse than all the fraud in all of mankind could ever. I am appalled beyond belief. And, I want to share this with anyone everyone... I OWN THIS PORBLEM this means I MYSELF WILL FIND THE MEANS TO DO SOMETHING TO HELP RESOLVE IT. Sorry about the caps, I was not yelling, rather I wanted to make a solid statement. One with confidence, and a feeling of inner calm, and peace like I have never had before.
Over 98% of the working aged people in the US do not know that they have what are termed "Secret" or "Hidden" rights by many types of business industry. And, of course knowing this to be the case they like to take full advantage of us. Aetna assumed wrongly that I would be forced into isolation and be made to feel shame for my need for wheels, and now that I am a disabled. Nope, not me people.
Instead of become bitter, angry, lost confused... I did those, though not so much as to prevent my find the evidence to prove my own medical needs, and every un-ethical, medically wrong, and illegal that they pulled on me.
If I had missed the error Aetna made on my claim, I would be living now at this moment in my own excrement with Aetna 100% fully aware they left me that way. All of course in the name of business. I agree making a profit is not bad, and should be fine. Not at the suffering, or worse of people however. That is what fired me up, and ever sense I have been contacting everyone I can.
How many people over the years of medical health insurance missed the error of the medical insurance company?
They may not had been able or even aware they could request the information I did that helped me.
How many loved ones suffered, all due to issues that there own providers may have created, but never found because they did not know they had rights?
How often does a child with a disability need medical attention, and is often denied?
And, what if a simple look and read of the full medical request packet would resolve oh say even 50% no that has to be much too high of an error rate or other issues that our medical insurance system would take advantage of, would you say? I mean if 98% of the people get taken advantage of, my goodness that, that is mind numbing how many people that actually covers.
Let's just go to the middle 1970's and start looking over things for errors, inconsistent medical notes made by well meaning medical professionals like mine who called the K0009 a K0002 however in the code it is easy to see that these are different correct? Now what if it is the way it really was in my case? 11/07 My patient appears to be in great discomfort and spent most of the time in his wheelchair that was pushed by his wife.
12/07 Patient returned to and appears to be much more comfortable in a lightweight wheelchair.
To be fair my Dr. is not one who deals with the K0009 style and class of wheelchairs, nope he mostly deals with what he stated. Now, what could that possibly mean. If I was a Nurse and or Dr, I would notice that as odd. Why can this patient be OK, in a lightweight depot wheelchair, and not in a standard depot wheelchair? At this point I would actually need to call the Dr, who write these notes to get a clearer picture of this. I mean, any number of things could be going on that on paper do not show.
A little issue such as calling something by the wrong name seems tiny, until you think of how many people over the years depend on our Medical System this covers Medicaid, and Medicare also not to abuse such a lack of public knowledge as this... I thought the same also.
Strong Memorial Hospital, The University of Rochester where I have worked for 7 years taught me tons more about the workings of this system than I ever imagined. I had for those years even as a secretary advocated hard for my patients. Notice I take ownership, it is MY place of work, it is MY job to do just what my employer wants me to do. That is to provide excellent customer service, and if that means I call your insurance and explain nicely how important that brand new medical whatever that will cost the insurance company $30,000 is nest if they allow the person life, or the chance to fight for life, or need the best possible DME as it meets that persons needs... I do not know how many thousands of people I have done this for now.
What my goal in this article is, is to maybe grab someone's attention enough to want to help me, and please laugh if you need to. I want to write the Professional Lay-person's Manual to the US Health Care System, you see I can translate from Medical, legal, and all the tech jargon to layperson speak and back. I have contacted PBS, as this information is so timeless and I feel important to our society, that I want to record it so that it can be shown to future generations.
Knowledge is in fact power, but all the knowledge that is available now, that I can locate is lost on over 98% of the working aged population, I only know because in the past I have worked for many companies that in the customer product realm of things took advantage of people just the same... And, the information I have can span a consumers layperson guide, and such for the customer in all of us.
How many of us disabled people did this:
4-25-08 Contact Insurance Company, and on 4-30-08 The highest level medical director on the Board of Directors is reading your information, and you are able to get the appeal overturned?
Please contact me if you can do this without threats, knowing anyone special or important, no yelling, demanding, no anger at all... Actually you will need to have fun doing it, also for people fearing this type of knowledge will help fraud... Nope. It can I guess. But, nope. The people who commit fraud will stay as far from this information as possible. I mean it is an open book to your medical life regarding the medical needs you have... And, more... It makes it fair for both sides equally to defend the position on the subject they may have, or rip it apart.
Laws, rules, ethics are all set things and need to be agreed to be followed, but if we never know we have them... How can we know what is wrong? What is a red flag?
How many people as I was also went insane at a denial, ended up in lock down of my own hospital where I had to fight like hell to come back to being my old self. Medicine would have caused me to have a full manic break. Yes, it was proven, as in three years sense I have not even had a oops moment. Stable moods, and no issues... Yes, it was my Dr who is shocked at my ability to recover who decided the medicine at the time was what sent me over the edge.
How many people could not make it back? The mental health system is horrid today.
How many people will kill themselves feeling they have no other options?
How many spouses will divorce?
How many families will break apart?
How many people will end up with more medical conditions because they accepted a K0001 wheelchair or anything else DME related that they needed a more ergonomic one of?
How many people will be denied the rights to know how to appeal?
How many people will even know these things?
Did you know that say a company like Aetna, if you wanted and are a customer could request ALL contact and other information they have on you. And, legally they need to comply, and they can not delete a thing, or claim to have lost anything in case you already have an identical set of documents yourself. Like I just happen to have myself. Also, this includes the notes they write on each call, and what ever else they store things on. Tapes, digital all of it needs to be sent to you if you request it.
Did you know that ERISA Section 502(a) as is the entire ERISA policy or law... Made me laugh so hard my ribs hurt. It was designed by and for the insurance industry, as a trippple (pun intended) talk way of covering the fact it protects the medical insurance company, and leaves you stuck with nothing to do.
Here is the break down as best as I got, to use ERISA first all appeals with your insurance need to be used. Then you need to prove 100% that your insurance company singled you out, and wanted to make an example of you, and make life worse, or you suffer needlessly as they profit from it. Of course Aetna did not pick me only, they do it equally to everyone. Imagine the look of there faces when I told them that. Also, in my case I have proof of the issues, and such I could prove 100% they messed up, illegally allowed laypeople to handle a medical decision, and do it 100%. And, the ERISA people will almost always side with the initial decision of the medical insurance company anyway.
Did you know in the situation where say a loaner DME was going to be asked for back, and leave you stuck in a certain creek with out that needed paddle... Your congress person can not tell the insurance company to give you approval. Same with any person in a government office.
The government can step in only after all internal appeals of your insurance company have been used. Well in my case that could take about a year more to happen... What will prevent me from living in sub human conditions? What if I fall and end up breaking a bone? The house catches fire?
This problem I discovered is much, much bigger than anything I ever first imaged.
Imagine the possible class action act that could be done, and instead of going for money... As in my case some money would help me avoid having my home taken, and to pay to have my yard cleaned... But, the problem would just keep on going.
Instead I think fine give a disabled person like me 52% ownership of the private medical insurance industries companies... I would not even need any money for it. I would actually have fun volunteering time. I have the blue print in my mind to allow the medical insurance system to run effectively, efficiently enough that it would make more profit that it ever has seen, yet provide lower rates to people, cover everyone, and provide the best medical access on the planet.
However, no one wants to take the work of some newly crippled guy, who has no PHD, nothing like these people that take excellent Icon companies and ram them into the ground... Yeah, I want the person who had a billion dollar record who may not have done it alone, and come to some other great American Company and in effect rape it as badly as the medical insurance industry rapes disabled people... Aetna, in effect started to rape me, if I did not get involved as I did... How could I expect anyone else to stop it?
SpinergyDude.LiveJournal.com where I do not get mad... I DO SOMETHING.
Now that you have read this, and are aware of the problem... I offer this to think about now...
If you find a problem and whine about it, expecting it to improve with no effort to change it... Nothing will happen to fix, or solve the problem.
I notice a problem, I am called into action. I will find the means, the way, the people, the team. In order to insure the masses of people who in one blink of an eye can end up... DISABLED just like most of us here. And, the biggest thing taken advantage of is newly disabled people hardly ever had the ability to do what I was able to do... What you may have had to do.
If you know of a problem, and feel you can do nothing. YOU become part of the problem.
I do not care if my blog needs to be shut down, and someone cover the cost of keeping it open... I will volunteer my full knowledge for free to EVERYONE who wants the professional layperson speak of the US Medical Health System... I might get it wrong, if so I admit it, and will change and learn what is correct. But, I will not become the problem...
Forced Isolation = Abuse of the disabled.
Let's together Spread the Knowledge... No one, and I am not kidding... No one can out sell me... I have taken that passion.... No one offers better customer service than me... I have taken that Determination.... And, I will Never, Never, Never Give Up, NEVER!
1995 partially disabled.... Today fully ABLED... Never felt more able to help more people in my entire lifetime... And, I can sign in over 2,200 people a month on average at Strong Orthopaedics and give each person 100% of the best customer service anyone has ever seen. Don't take my word for it, but my boss has told me that my job will never be filled, and no matter how long it takes it will be waiting for me, wheelchair or not... Just get out of pain... It has been almost almost 2 years now, and the position is still open. No one, I mean no one has more determination, passion, love, joy, happiness from helping people who are in the same boat as I am... Oops, I need to start paddling... Wait.. oh no... I dropped the paddle.... again.... O,o
Thank you for taking the time to read this. If should anyone at all with to ask me questions feel welcome to do so. I am no one special, but to me the people I want to reach are.
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