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Alliswell2 Asked September 2013

How do I get help through our insurance companies for an upcoming surgery?

My husband has been disabled for 9 years, is 57 years old, has Medicare and BCBSNC but the insurance companies said they will not pay for a caregiver after an upcoming surgery that will require him to not put any pressure on his foot. I work full-time and am taking off 1 week but he will be unable to take care of himself for the next 4 weeks. He cannot use crutches, due to vertigo and spinal problems and cannot get around the apartment on his own through the narrow doors in our apartment. He needs someone to help him get ready in the mornings, walk his "service dog”, and get his meals. Where do I go to get help? We cannot afford to pay for in-home care due to all the medical bills. My husband has a long, long list of medical problems. HELP!

Alliswell2 Sep 2013
Thank you for the great ideas. I am a receptionist so I get 1 hour for lunch and it takes 40 minutes to get home. Tough part is we are moving to a different side of town on Oct. 5 so we will be new in the community and have not found a church by then. Hopefully we will and that would be a great help. The "Cooler," I will definitely do, He is going to have to walk the dog and I think he might be able to with his electric wheelchair. He can at least get out the larger outside door with his electric wheelchair. He has a catheter bag so that is fine until he needs to empty it. So the urinal will work well. The service dog is a huge help because he can get the phone for my husband and open the door for the medics if something happens. We have decided to get a 4 wheeled walker with a seat so he can put his knee on it and push with his good leg. We will add a basket so he can transport drinks, food whatever to his recliner. If his vertigo sets in he will have his seat on the walker to sit in. Not a great option but it is something. The doctor and nurse are absolutely no help whatsoever. I need to call his cardiologist, neurologist and spine doctors to see if they can write notes for us to give to the insurance companies. This is really a huge pain. Please everyone keep sending me your great ideas! You are all so helpful. I needed that. Blessings

sunflo2 Sep 2013
Yes, check with insurance company and see what you can work out. Secondly, speak again with the dr and ask for his help in recommending care, even if its only a few hours daily.

You might also check with family, friends, church, neighbors to see how they can help. For example, a neighbor teen MIT be able to walk the dog before and after school.

Talk with your employer, maybe you can work something out where you can go home at lunch. I'm not certain of your circumstances, but some employers allow their employees to donate their leave to another employee in need so they can be off and get paid leave. This might buy you some extra leave time. Do you have a job that you could work remotely via computer for some of the days?

You obviously will have to get up earlier to help him get ready. Maybe rent a portable toilet chair or urine jug to use if he can't get up and be mobile to bathroom during the day. You could pack lunch, drinks, snacks in a cooler and have the cooler stationed by the couch so he can get by during the day while you are out of the house.

This is tough, but you'll have to get creative if you can't get assistance and the surgery is necessary.

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Alliswell2 Sep 2013
I will check out the letters from Medicare and BCBS. The doctor said he would have to have a reason for home care like needing physical therapy or a wound change but those visits are usually quick in the home and out they go. I will call Medicare and BCBS to see what they tell me. If that does not work, I will go to www.change.org and have people from Facebook sign it. Thanks for the info.

blannie Sep 2013
This is slightly off topic, but I see from your profile that your husband is on 27 medications. Have you ever had a geriatric pharmacist review his medications to make sure that he needs all of them and they're not in conflict with each other? That's the first thing I'd do. That seems like a LOT of medication for anyone to be on.

Do you have a written denial from BCBS (I'm not sure what NC means at the end of the BCBS) about your husband's post-surgery care? If so, I'd contest it up the chain of command at BC/BS. Has your husband's doctor prescribed home care? See if he can do that. If those two things don't work, I'd start a petition on Change dot org - I can't put the website link here or they'll take it out - about your situation. Get friends and family to sign it and get it posted on Facebook. That route has resulted in many, many people getting whatever they're petitioning about. BC/BS won't like the negative publicity.

Another thing I'd wonder about is whether Obamacare (which starts in October) might offer better benefits. Can your husband wait for his surgery? Can you check out if the benefits will change next month? I'd also check that out. Good luck, you've got your hands full. Please keep us posted on what happens.

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