Thanks to all that have helped!!!

Wednesday, February 15, 2012

Denied

My resolve has been tested today. I have to admit, I got the wind knocked out of me. It's been quite awhile since I've let doubt creep in like it has today. I got a phone call from the company that I'm working with to get and fit my prosthetic. It seems Humana Insurance surprised them by not only denying my knee, but they denied everything. They denied the knee, the socket, the foot...everything that has to do with me walking. Humana is the only major insurance company left that does not provide a way to get the microprocessor controlled prosthetics, and their bullish actions have got me worried. They responded to my prosthesist that until they provide a request that includes a mechanical knee that is covered by Humana, they will continue to deny me. What does this mean for me you ask...it means my dream of being a paramedic stops here. Luckily, Kentucky Prosthetics isn't leaving at that. They have vowed to go above the head of the medical director of Humana and get me the knee I need. Just for the first time, the magnitude of what I am trying to achieve is hitting me in the face. I am worried that it may take much longer than anticipated to get me up walking. I would love to see this medical director face some of these decisions I am having to make only to have some guy reading a chart decide that he doesn't deserve what he needs to live the life he wants. Don't get me wrong. I'm not wishing this upon this man, I would never wish anything that I have went through on another human being. I just wish he could look at what his decisions do to the people. I have been assured that I have nothing to worry about, but when it deals with my life and the well being of my family I am going to worry. I just hate that as of right now there is nothing I can do. I am once again stuck and leaving the decisions that effect me and my family in the hands of somebody else. I trust the people at Kentucky Prosthetics. That's what made me decide to give them my business. So now, I am trusting them to get me what I need. Obviously, this creates a system of worry. I try not to let this get out, I put on my mask and pretend to be OK. Well, this knocked me down and I can assure you, right now, I am not OK with this. So, as we speak my first denial letter is on the way to Kentucky Prosthetics and they will take this to Louisville Metro Government to the lady who makes the decisions to over-ride Humana's decision. This could take months, they could decide that they want Humana to deny me 2 more times before they will step in. I'm praying that she will take into account what I am trying to achieve and have mercy. I'm just freaking out, because honestly, I don't know how Kate and I are going to make it, if we have to wait much longer. We are fighting tooth and nail, and luckily we have received donations from friends, family, and some of my readers. This has helped take some of the edge off, but this could last months longer than we expected, and I'm not sure how much longer people will be able to give. So, tonight I end this post broken and scared of tomorrow. I haven't felt this way since I was lying in the hospital with my original injury. I had always either been sitting still or moving forward, today I feel like I was knocked backwards. Tomorrow, I will get up and regroup, figure out what I can do to change their minds. Who knows, maybe the lady who decides my fate will stumble across my blog and see how determined I am. At any rate, tomorrow is a new day.

7 comments:

  1. I say you get the media involved and ask for a meeting on the front steps of Humana. Have Med Units, fire trucks and police cars and private ambulance services honk and drive by showing you support.

    James

    ReplyDelete
    Replies
    1. loved that mental picture!!!! X-D This ought to be for ALL aumptees that wanted to return to emergency/medical fields....

      Delete
  2. Insurance sucks balls. I'm sorry you are having to go through this and am praying that they wake up and you get your leg sooner rather than later!

    ReplyDelete
  3. Joe, there will be small victories and small loses. There will also be big loses and big victories. Keep after it!

    Other readers may wish to contact @HumanaHelp on Twitter.

    ReplyDelete
  4. Hang in there, Joe. Insurance companies are just like this; denying claims is how they work. Many people don't jump through their hoops, and they save a lot that way. But you're not going to quit. Good to hear Kentucky Prosthetics is stepping up for you.

    Would contacting Humana actually help things, do you think?

    ReplyDelete
  5. As it neared the top of the grade, which had so discouraged the larger engines, it went more slowly. However, it still kept saying, "I--think--I--can, I--think--I--can." It reached the top by drawing on bravery and then went on down the grade, congratulating itself by saying, "I thought I could, I thought I could."

    Don't loose hope, we're rooting for you!

    ReplyDelete
  6. Joe, I am sorry that you have Humana. They are the least patient friendly insurance company in the state. I am truly sorry you have to fight them for your prosthetic. Their policy is to deny everything first, then after long battles, they finally approve these requests. Don't give up.

    ReplyDelete