Disability

Recieving disability payments is more difficult than one might think. To catch you up, I recieved Short Term Disability payments through my employer over the summer. After an initial denial of my claim, I appealed the decision and eventually was approved based on a suspected diagnosis (and the pulling of strings of top executives in the company). With Long Term Disability, I have not been so lucky. My initial claim was denied because they did not see sufficient evidence in my medical record to prove that I am, in fact, disabled.

Let me tell you, this is a very disheartening event–to have an insurance company extract quotes from medical records that “prove” I am qualified physically to work. Infuriating and insulting is more like it. They included one quote from my cardiologists note that stated on July 30, 2012 this doctor states “she is alert and oriented”. OK, insurance company. Just because you can recall the date and know what type of building you are in does not mean that you can work 12 hour shifts as a nurse. They also decided to ignore the rest of the note which states that everytime I stand up, my heart rate skyrockets to 170 and I have episodes of near syncope.

They extracted another statement from my neurologist that said that the small fiber biopsies were normal and negative for demyelenation. BUT, what they failed to research is the fact that you don’t need small fiber biopsies to be positive to diagnose autonomic failure or dysfunction. They decided to ignore that fact as well.

I had my cardiologist fill out the physical capability form for the disability claim because he is closely following my case. He clearly stated that I cannot stand, lift, or walk. My physical capabilities are limited to activities of daily living ONLY. Surprisingly, there was no mention of this document at all in the denial letter.

All this being said, I am currently in the process of appealing the decision. This could take up to 6 months. The worst part about all these minor details is that I AM SICK. I have no energy to sit up and research the policies, obtain all my medical records, call lawyers, etc. It seems almost impossible. But, I press on.

I will lose my empolyment offically next month–which means I will lose my health insurance. There is always COBRA, but without disability payments, that will depleat my savings quickly. Even with disability payments, I won’t be able to cover my rent, expenses, COBRA payments, or medical bills. It is also possible that I will be recieving treatment in the near future–an infusion that costs $10,000 a bottle. Five infusions in a treatment session, repeated every 6 weeks to 2 months until you are better.

At this point I’m simply frustrated. Unable to do much because of my current symptoms, I am stuck here just thinking about the claims and the impending financial difficulties.

It seems to me that there is something wrong with this healthcare system. So far, I have slipped through the cracks, been denied short and long term payments, and been passed around from specialist to specialist. You would think that I, an educated nurse, would be able to navigate the system–think again.

Everyday I would go to work as a nurse and treat my patients with dignity and respect. I would defend and protect my patients until the end. I worked hard to uphold the standards that my employer drilled into us. All I ask is to be treated by my employer and their insurance providers with the same dignity and respect  that I worked so hard to achieve for my patients.

Is that too much to ask?

20 Comments on “Disability

  1. sarah, have you contacted Allsup? I work in case management and we refer to them all the time; they win the majority of their cases the first time around. google them; god bless and good luck. 🙂

  2. Sarah, poor dear, you have learned more about our healthcare system at your young age than anyone should have to. I have no doubt that you’ll be able to get the LTD decision reversed–it’s just standard operating procedure to deny every claim initially. The entire system is set up to pile on torture after torture for people who are already sick. Eventually they will cave in, but not without a fight, and it’s obscene that patients have to go through this.

    The longer term question of your employment status is even more troubling, and that–unfortunately–doesn’t have a good answer right now. As long as we as a society are dependent on our employment status for ensuring we have adequate medical coverage, we are screwed. This is when “compassionate conservatism” seems like such a cruel joke. There has to be a better way than our current insurance company-driven healthcare system, and there is, but sadly, the insurance companies–and the masses of deluded Republicans out there–will fight it tooth and nail.

    • Diane- Thanks for reading and for the support. Yes, this is so frustrating. I cannot believe we live in such a great country with a medical system that is just plain broken. Not sure what the right answer is–no doubt, any changes will take decades to truly see their impact. We may not live to see that change, honestly. Until then, we will just have to fight it as best we can! Thanks again for commenting. See you soon!

  3. I too am a SarahBeth, RN! Weird. Saw your post retweeted to my timeline. I feel your pain. A few years ago I was in a similar situation. It did get better. Right now I am fighting to get any insurance coverage at all, as I am agency contract and don’t have insurance as an option. Can’t get private insurance either. Our system is horribly flawed. I need to see a surgeon, but his office has a policy of not taking private pay patients at all. It is a screwed up world when people are denied options or have to choose between mortgage or health. But according to certain parties we have no issues with access to care.

    • I’m so sorry to hear that! This system is definitely messed up! Not sure what the answer is, if any. Thank you for reading and for the support. Glad to hear there is another SarahBethRN representing in the nursing world!

  4. I am sorry to hear your oh-too-common story about this sh*t. Hang in there, ask for help from your friends and family, press on when you can. Let it go when you cannot. It is MADDENING that sick people have to solve these kinds of problems!

    • Everybody gets turned down on their first Social Security application. It is well know and standard procedure with them. Try going to a self insured group like Farm Beareau. To join them is like $30.00/yr, get your car insurance with them then you will be elegible for the health plan that they carry as a group health insurance. I have done this in two states and had excellent BC/BS coverage from them each time.

      • If you join Farm Bureau, you will then be eligible for their GROUP BC/BS in the state that you live in. I live in TN. and go to Mayo Clinic every 3 months and they pay for all the Mayo Bills that I incur. Sometimes you will not be covered for a preexisting condition for 1 yr. but after that you will become completely elegible. A Physician actually told me about this way to get health insurance as I had a son who was asthmatic and my husband lost his
        job. Because of my preexsisting condition we paid Cobra for a year for me
        then the BC/BS covered everything. This a way around the insurance issues that have worked very well for us. This is one of the reasons I do not want to claim disability as you will then have to have Medicare and I do not want my healthcare in the gov. hands. I KNOW they would not pay me for going to Mayo Clinic every 3 mos. Email me if you wish linda@hagemanfoundation.org

  5. Don’t know what state you’re in, but BC/BS provides horrific coverage to individual policy holders in mine (it’s a for-profit BC/BS, not that the not-for-profit BC/BS companies are necessarily better) meaning they challenge and deny payment as a matter of course. Just because you recognize the name of the company doesn’t mean all their policies are good, especially in the individual market. You will have to go to a PCIP plan if you don’t utilize COBRA, so it’s wise to check out costs and compare, not that you feel like doing that while you’re feeling lousy.

    This is why we need universal healthcare in this country. This system is set up for the healthy, young and employed. Best of luck.

    • Sarabeth, hope you are feeling better!
      I also recommended Allsup. They got my SSDI, & there are no yearly follow ups or Dr’s letters required according to SS.
      I first read your blog & discovered the POTS specialist here in N central Tx. I only have Tachy beats, he ruled out POTS! I hope you get the insurance board to understand, because it is hard to function with that. Good luck!

  6. It is hard….first of all, the identity most nurses have is that of being a nurse- NOT the patient- then having to ‘prove’ that staying conscious really is a problem (I’ve got dysautonomia as well, and have been disabled since 2004). If you have LTD through your work, it should help with Social Security disability… One option is to ask for a referral to Social Services – it is amazing how they can help. Medicaid is a pain in the butt, and the “monthly deductibles” (spend-downs) are outrageous, but if you’re going to need infusions that are $10K, you’re going to need it. It’s a maze that I never considered when I was taking care of someone. They needed help/care, and that’s all that matters. Plug in the bean counters, and it all goes belly up. I still miss working, but I can’t get through a trip to the grocery store without being done for the day after a one hour trip (need the cart for support). Hang in there. Many social security attorneys will look at your case, and not charge unless they win. Of course, they get a cut- but they can help with the red tape. <3

    • Thank you so much for the support! Unfortunately, I am currently appealing the LTD claim through my employer. Once I figure that out, I guess I will have to move on to Social Security. I will need to contact one of those companies that helps with the claims for sure. Thank you for reading!

      • It’s hard being a nurse who becomes the patient. It took me many years to come to terms with it- and I still have trouble not working. I’d give anything for another day taking care of patients. I hope the appeal goes well. Social Security isn’t as bad if you have LTD already in place (IMHO). I only had to apply once.

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  8. You’re certainly not alone in your frustration. It took me three years to get disability from the govt. They look for any little thing that they think will say you can work despite all the other evidence that says you can’t. It’s ridiculous. Hang in there. I feel your pain.

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