How do you cope when everything's falling apart?

[VisionaryMom]

So, our insurance company is fighting paying for DH's biopsy - and his treatment, as an extension. We have to fill out papers about his medical history, past insurance coverage, etc., and then of course our doctors' office needs to fill paperwork out as well. Then the insurance company will make a decision w/i 15 days. The problem is that DH's surgery was scheduled for yesterday. He pushed it back to the 26th because Humana was "reviewing" the biopsy claim. Then we got the letter yesterday about being unsure whether they're paying. So, DH wants to push his surgery back *again* because we will need to know how to proceed if it's not covered. (Plus, the biopsy should count toward our deductible, and we were hoping to have that in place before we went for the surgery.)

Then this morning, I got up to a huge storm outside. And then the ceiling in the dining room started leaking. So now I have to figure that out. I've never dealt with homeowners' insurance, don't even know how that works, and besides we have a pretty hefty deductible with them.

That on top of DH's car dying last week (which we knew was coming) and my car blowing a tire (pretty new tires!!!) and needing other work from the damage that caused.

I just want to curl up in a ball and cry. How do you get through these times?

[SC_Jan]

I usually don't handle things like that well, to be honest. I usually drink too much and put everything off because I don't want to deal with it. Not really a method I recommend, FYI.

I would look into getting a patch on your roof which might be cheaper than meeting your deductible.

Can the hospital where your husband's surgery is scheduled check with insurance on your behalf? They have a financial interest in helping you out. This is the time of year when hospitals have the fewest procedures scheduled so they have more time and motivation to help. We have some amazing women at my hospital who can be very helpful, but patients do have to ask in most cases.

You are dealing with a LOT right now. Be good to yourself before you do anything else. When I get overwhelmed like this I write down each step I plan to take because otherwise I freeze up. For example:

1. look up hospital number
2. tell operator I need help with insurance
3. and so on...

The car part I know nothing about. Just sending lots of positive vibes your way. Good luck, mama.

[CarrieMF]

Get up on the roof & look for lifting shingles/holes & tar it up. It'll save ALOT of money if you can find the spot. Look under the eaves for holes & around any vents if there are some.

[pbjmama]

I get through tough times by asking for help! Even if it is something little like asking someone to watch your kids while you make calls/appts to deal with this stuff, someone to schedule some meals to be delivered, whatever you need. I'm sure you have family and friends, just ask! I would hate to find out after the fact that a friend needed help and I didn't even know about it!

As far as medical insurance I would contact the hospital and see if they can help you sort it out. It is win-win for them to help you and they already have people set up to help. If you can't afford it and your insurance won't pay then you may (probably ) qualify for charity care.

For your house, call your agent and ask what options you have.

[VisionaryMom]

Originally Posted by SC_Jan

I usually don't handle things like that well, to be honest. I usually drink too much and put everything off because I don't want to deal with it. Not really a method I recommend, FYI.

Hey, this is my plan, too! Last night, I just had a few glasses of wine. But I probably should look for something more sustainable for the long term.

Originally Posted by SC_Jan

You are dealing with a LOT right now. Be good to yourself before you do anything else. When I get overwhelmed like this I write down each step I plan to take because otherwise I freeze up.

I do need to list everything out. I'm just so overwhelmed with things to do. DH is...kind of helpful. If I tell him to do something, he will, but he waits for me to plan it and tell him.

Originally Posted by SC_Jan

The car part I know nothing about. Just sending lots of positive vibes your way. Good luck, mama.

DH has to junk his car. As I said, we knew it was coming. It's just a bit earlier than we'd anticipated, and we weren't planning on buying something until next summer. We're going to make it on one car until next spring, and then he's getting a motorcycle.

For my car, it's going to be an inconvenience more than anything to get it repaired. I have no idea how much it will cost or if the problems are imminent, but we're working on them.

Originally Posted by CarrieMF

Get up on the roof & look for lifting shingles/holes & tar it up. It'll save ALOT of money if you can find the spot. Look under the eaves for holes & around any vents if there are some.

Hmm. I'll have to see if we can borrow a contractor ladder from a neighbor. We have a ladder, but it's not tall enough for us to get on the roof. My concern is that we'll have to fix the roof eventually, and then if it's really pricey, the insurance won't pay because we patch-worked it.

Originally Posted by pbjmama

I get through tough times by asking for help!

I would, but I really don't have anyone I can ask to help. We have no family nearby. The kids are going to my ILs the first week of August, so I'm hoping we can hang on until then.

Originally Posted by pbjmama

As far as medical insurance I would contact the hospital and see if they can help you sort it out. It is win-win for them to help you and they already have people set up to help. If you can't afford it and your insurance won't pay then you may (probably ) qualify for charity care.

We don't quality for any type of charity care. It's not that we need charity care. It's that we need a payment plan. We've eaten through savings with one emergency after another over the past year, and we can't pay out of pocket for the procedure, which is what they want. So we're going to get some answer from the insurance company and then see how we proceed. My guess is that we'll have to find a different - less convenient - place for the procedure so that we can pay in installments. We have to pay $500 upfront no matter what, and really you'd think that would be a good starting point.

[SC_Jan]

Hope you enjoyed your wine! I'm still advocating for calling the hospital. They REALLY WANT your business right now. This crummy economy leads people to put off procedures so total surgeries are down. Summer months are always low census, so this year summer months are terrible for those of us in healthcare. Believe me, billing will be bulldogs on your behalf if it gets you in the door.

I work for a non-profit and can tell you that sliding scale, payment plans, etc. are all very realistic possibilities. I think you are in a good position to get some help even if you are dealing with a for profit. I am not talking about charity care. I am talking about getting people in the hospital who work with insurance companies ALL DAY LONG to call your insurance company on your behalf. If your insurance coverage turns out not to be so great, you may also be able to negotiate the remainder of the bill.

[shelbean91]

If the reason Humana is denying the claim is bogus, go ahead with treatment and fight through appeals. It sounds like it's something relatively urgent.

I dealt with appeals through an insurance company for over a year to treat my vericose veins. First they said it was a medical condition but experimental treatment, then they said it wasn't experimental but wasn't medical, just cosmetic. I ended up fighting and filing appeals all the way through the state and won. Waiting for me wasn't too bad, though.

Worst case scenario, you'll pay. Will you not treat if that's the case or will you talk to dr's and set up paymetn plans? If you know you're right, wait it out.

Hang in there - take a deep breath - and know you will make it!

[honeybunmom]

If either of you are working and the employer has an Employee Assistance Program, it is perfect for situations like these. You can talk to someone for free and they can help you identify helpful resources. I finally took advantage of mine and am seeing some light at the end of the tunnel . . . albeit a very long tunnel!

Oh, and you said your tires were relatively new . . . . do you still have the paperwork on them? Might they still be under warranty?

[Chamomile Girl]

Originally Posted by honeybunmom

Oh, and you said your tires were relatively new . . . . do you still have the paperwork on them? Might they still be under warranty?

Most tire places will stand behind their product and fix or replace the tire for free.

[VisionaryMom]

I will check into EAP tomorrow. The benes are through DH's work, so I don't always have all of the relevant info. It's probably in his desk somewhere.

They're trying to deny it as a pre-existing condition. Hubby is a government contractor. His contract vendor lost their position early in 2010, so we had to switch contract companies, which meant a change in insurance. DH's GP referred him to the specialist back when we were on the old insurance, but the appointment wasn't until we had the new coverage. So they're going to deny it.

I think I could work something out, but DH is just so dead set against going before Humana makes a decision. He has a serious problem with insurance companies, which I share but still...

Our premiums are $450 a month, and we put $200 a month into medical flex (but we can't get that back until after it's filed with the insurance company).

===

Car - I'm pretty sure the tires were under warranty, but I was 400 miles from home when it happened. So I don't know how that part of things works, and frankly it's done & paid for, and I don't need an extra errand right now.

[SC_Jan]

Did you have a period of time when you were not insured? Otherwise, typical policies can't deny you for pre-existing conditions. Not to beat a dead horse but I would get the hospital calling Humana on your behalf. I think all insurance companies are pulling as much crap as they can get away with right now in case the gravy train ends.

I'm getting denied on all kinds of things that are covered in my policy. They're just hoping I don't notice and call them on it. My human resources department is worn out trying to get things reprocessed correctlyfor employees here. Could HR at your husband's workplace help? There are people being paid to deal with these issues; maybe they can free you up for some drinking time .

Also, I noticed you said you might need to use a less convenient hospital. Could you let your hospital of choice know what the competition is offering and see if they will match? It totally stinks to have all this stress on top of ill health. I really hate American Health Care.

[VisionaryMom]

Originally Posted by SC_Jan

Did you have a period of time when you were not insured?

My human resources department is worn out trying to get things reprocessed correctlyfor employees here. Could HR at your husband's workplace help?

Also, I noticed you said you might need to use a less convenient hospital. Could you let your hospital of choice know what the competition is offering and see if they will match?

We've been covered, but I think it's just an attempt to get out of paying. You know, maybe we won't say anything and will just pony up the money. Grr.

HR - I don't know. The company HQ isn't here, and they're not always responsive. They're not bad, but they're also dealing with state-mandated furloughs right now (which is its own gripe...). So I will see. Plus, DH is just acting like nothing's happening. MIL called to get on his case about wanting to put it off indefinitely (his plan), and he's just flabbergasted. I mean, can you believe his mother would want him to get this cancerous spot removed??? What is she thinking? So, yeah, I'm trying to get through the week and then I can sit down and talk to him.


Good idea on letting the local hospital know if we can get a deal elsewhere. I know they hurt (we all do) when people can't/won't pay up, but I mean they're ridiculous. They won't even give us an estimate, just a "be prepared to pay in full on the day of the procedure." Of course I have considered letting them do the procedure and then saying "okay, this is what I can give you today." Seems unethical, but it's not like I'm not going to pay them eventually - just not this month.

[Om Girl]

Check around and see if instead of junking DH's car you can donate it for a tax break!

There's a ton of organizations around here that do it and that's what we plan on doing when my DH's car inevitably bites the bullet!

[shelbean91]

As long as you can prove continuous coverage, the preexisting clause isn't an issue. Under FMLA passed in 1993 (I think that's it) - preexising is only an issue if there is more than 63 days without coverage. I've got asthma and have changed companies several times - every now and then I get a rejection for 'preexisitng' and just have to send a copy of prior coverage.

[lmonter]

I do a lot of crying. And get up in the morning and deal with the kids all day and so on. My plethora of current issues is different, but still. You just do what you can to survive.

Oh, and write down every. single. time. you talk to someone from the doc office, hospital, insurance company, etc. Date, time, person, extension number, summary of discussion, etc.
I had hospital billing issues after my oldest was born, and I swear, I could hear the folks at the billing dept cringe every time I called because I could back up what I was saying with names and dates and everything. Hey, had to cover my rear end.