And Now, The Rest of the Story…

This will be my final post about my personal odyssey with the fine folks at Anthem. It will be brief, just to update those of you who’ve been so kind with your suggestions and good wishes.

You will be happy to know that Anthem has made medical school unnecessary.

Yep–when they finally returned the multiple calls from the hospital doctors, and those doctors had once again gone through the charts, the X rays, the reports from in-hospital PT, etc., they were told that according to Anthem’s algorithm, I am not a candidate for rehab.

Their algorithm, you see, knows more about my condition and needs than the medical personnel who actually examined and treated me.

As one doctor said, “why did I waste all that time in medical school?”

I’m going home. My younger grandchildren will come over to help my husband with my care, at least for a couple of days, and we’ll figure it all out. (As those of you who know me know, I’m a tough old bird.) But everyone in this situation–as you  can see from the multitude of comments here on the blog and on Facebook–isn’t as fortunate as I am, doesn’t have a support network that can step in. And according to the doctors and caseworker, I am far, far from the only person facing this bureaucratic malpractice. And I will follow up on several of your recommendations for filing complaints, etc., in hopes that I can keep at least some others from going through a similar fiasco.

The United States is the only developed country in the world that has chosen to socialize its medical care through the insurance industry.

I asked one of the doctors if they have these same problems with Medicare. They don’t.

For now, this blog will return to its originally-scheduled programming.


Inexplicable, Costly and Wrong; An “Extra” Blog

Okay, I defy anyone to explain this to me.

As regular readers know, I’m in the hospital recuperating from a nasty fall. I broke my pelvis and my clavicle. I’ve been here 8 days, although the doctors wanted to send me to acute rehab three days ago. (Acute rehab is apparently more intensive, appropriate for people who have been active and can be expected to respond to longer sessions of physical therapy–and thus leave for home more quickly.)

This morning, I was finally supposed to be transferred. But then, Anthem, my “insurance” company (note the quotes) rejected the doctors’ advice and denied the move. According to the caseworker, since the first of the year, insurers have been denying approximately 50% of requested moves to acute rehab. Without seeing the patients, without consulting with their doctors. The hospital can and does appeal, and about half of those “peer to peer” appeals are granted–we’ll see what happens with mine–but even the appeal process evidently becomes a game; calls are routinely returned after hours, for example, when the insurance company knows the physician won’t be available, prolonging the process.

But here’s what is insane: keeping me in the hospital costs more than sending me to rehab.

Why would a company that should want to keep costs down opt for a placement that (1) is medically inappropriate; and (2) costs more? Why did the approval process suddenly become more arduous at the beginning of the year? What is the larger game being played in which I find myself a pawn? And what therapy will Anthem pay for? Anything? Or is my 83-year-old husband supposed to drag me up the stairs at our home and help me in and out of bed when nature calls?

Tell me again how horrible single-payer systems are