Fucked

[xela]

I am being discharged tomorrow. I am not ready to go home. My home is not ready for me to be there. I had, until late Friday, thought the odds were pretty good that my caregivers would be able to get a few more days out of BCBS on the grounds that I am not yet ready to safely do things like transfer myself from bed to wheelchair (or wheelchair to commode, or any of the various et-ceteras and vice-versas one might care to imagine). I have spent all day trying to figure out whom to appeal to (since BCBS told me late Friday that Neville Center had not asked to extend my stay beyond Tuesday, so they hadn't denied anything, so there was no decision of theirs to appeal). So I spent all day waiting for the promised visit from my "Care Coordinator" here. When I finally decided to call BCBS again to see whether anything had changed since Friday, I discovered that the office there that deals with these matters closes at 16:30. I then finally received the promised visit from my care coordinator, who told me that she had been told ten minutes before BCBS closed that the physician who had reviewed my record had denied any extension beyond tomorrow. And that if I appealed and they kept me here, my appeal could take two weeks, and ifndenied, I would be responsible for the bills. (In contrast to what someone at BCBS told me when I asked about appealing my discharge from Sherrill House, which was even more obviously premature, which was that the appeal would be decided within at most a few days, and that while it was pending, BCBS would be responsible for the bills.)

So I am, right now, feeling pretty fucked. If I go home, it will be by ambulance, because carrying me up my front steps is the only way I can currently get in the house. I will then be stuck at home for at least the next month, able to leave only by ambulance (a bill I will have to pay, unless (touch wood) I have to go to the ER). Or I can have a wheelchair ramp installed temporarily. Which, crazy as it is, is probably the more realistic option. Because I am sure as hell going to have a number of medical appointments I'm going to have to make it to over the next month or so, before I can walk again.

So right now I'm feeling pretty fucked.

If anyone is available tomorrow afternoon to help make the impossible only take a little longer, please let me know. email xela AT mit.edu tel +1.617 901 6954 --- though note that my phone is unreliable and often goes straight to email, so TXT is better there. Also, until some point after 11:00, I will continue to be available in room 115 at Neville Center, 640 Concord Ave, Cambridge --- tel +1.617 497 0600 x135

---

Edit: The original timestamp on this should have been around 18:00. But because the day hadn't been fucked enough, right around then my Mac decided to start having kittens. I spent better than an hour being patient with it, before finally force-rebooting. I feel lucky to have recovered my final draft.

Comments

[angerona.livejournal.com]

Sucks :(

http://benefits.adobe.com/sites/default/files/8-BCBS_MA_Point-of-Service%20Benefit_Description%201-1-2014.pdf
reading here (don't know where that link is from -- just googled it), it looks like they need to have given you a written notice of your impending discharge, and your physician needs to have appealed it:

In other cases, based on a
medical necessity
determination,
Blue Cross and Blue Shield
may determine
that you no longer need
inpatient
coverage in that health care facility. Or, you may no longer need
inpatient
coverage at all.
Blue Cross and Blue Shield
will make this decision within one working day of
receiving all necessary information.
Blue Cross and Blue Shield
will call the health care facility to let
them know of this decision.
Blue Cross and Blue Shield
will discuss plans for continued coverage in a
health care setting that better meets your needs. Th
is phone call will be made within 24 hours of the
Blue
Cross and Blue Shield
coverage decision. For example, your condition may no longer require
inpatient
coverage in a hospital, but it still
may require skilled nursing coverage. If this is the case, your physician
may decide to transfer you to a skilled nursing facili
ty. Any proposed plans will be discussed with you by
your physician. All arrangements for discharge
planning will be confirmed in writing with you.
Blue
Cross and Blue Shield
will send this written (or electronic) notice to you and to the facility within one
working day of that phone call to the facility. You may c
hoose to stay in the health care facility after you
have been told by your health care provider
or
Blue Cross and Blue Shield
that
inpatient
coverage is no
longer
medically
necessary
. But, if you do, this health plan will
not provide any more
coverage. You must
pay all costs for the rest of that
inpatient
stay. This starts from the date the written notice is sent to you
from
Blue Cross and Blue Shield
.
Reconsideration of Adverse Determination
Your health care provider may ask that
Blue Cross and Blue Shield
reconsider its decision when
Blue
Cross and Blue Shield
has determined that continued
inpatient
coverage is not
medically necessary
for
your condition. In this case,
Blue Cross and Blue Shield
will arrange for the decision to be reviewed by a
clinical peer reviewer. This review will be held be
tween your health care provider and the clinical peer
reviewer. And, it will be held within one working day
of the date that your health care provider asks for
the
Blue Cross and Blue Shield
decision to be reconsidered. If the initial decision is not reversed, you (or
the health care provider on your behalf) may ask fo
r a formal review. The process to ask for a formal
review is described in Part 10 of
this benefit booklet. You may request a formal review even if your
health care provider has not asked that the
Blue Cross and Blue Shield
decision be reconsidered.


Have you received a written notice?

I can visit tomorrow 11am-noon or 1pm-2pm. Sorry for the brief time periods :(.

Unfortunately, it sounds like you may not be around either one of those :(.

I don't know if I can help in any way. I suppose I can walk around saying "I"m a lawyer" -- but that's unlikely to work (I don't look threatening enough most of the time).

[yakshaver.livejournal.com]

Thank you. They did send written notice, on Jan. 19. To my home address. Which I received this evening, after writing the post, due to the kindness of Cyrus, who brought me my mail after taking in my mattress. But I will most definitely be talking to my doctor first thing in the morning.

[pekmez.livejournal.com]

Doesn't MBTA's The Ride van service do wheelchair transport? I don't know if they will cope with a home with no ramp out the front door, though.