Again, someone who has not had to navigate through the utter hell that is Medicare.
Let me tell a story about my mom and Medicare.
My mom has advanced MS. She is quadripalegic. The only thing she is able to do is turn her head slightly. Maybe she has 30-40° of range (total, not each direction).
My mom has advanced MS. She is quadripalegic. The only thing she is able to do is turn her head slightly. Maybe she has 30-40° of range (total, not each direction).
For years she had the same motorized chair they had purchased, which was designed for someone to operate via a control stick on the arm. It was fine until she lost the use of her hands.
If they went anywhere my dad would have to walk beside her and operate the chair. The stick was sensitive, so it was hard to keep it from swerving. My mom, prone to motion sickness, would often get extremely nauseous.
Plus the seat was extremely uncomfortable. In a cruel example of the universe giving us the finger, MS kills the nerves necessary for motor control, but leaves pain receptors intact. Nice, huh?
Think about an airline seat. It was roughly similar to that. It's fine for a couple of hours, but you sit long enough and your legs kind of start to burn a bit. That's what it was like for her. After 3-4 hours she was so miserable that my dad would have to take her home.
Imagine being bedridden for 18-20 hours a day (some days more) and you *can't even operate a remote control so that you can change the channel without help*. You can't even scratch your nose if you get an itch. But you can't be mobile because your chair is worse.
So finally my wife and sister-in-law tell them that there are good chairs that can be controlled by head movement, can tilt (which makes it a lot easier to do things like go to a movie, where the wheelchair accessible areas are near the front), are more comfortable etc.
My mom has Medicare Parts C and D. DME (specifically, motorized wheelchairs) are supposedly covered, if medically necessary. Remember that term.
After doing some research on their own, my wife and s-i-l found a chair that was perfect. It wasn't cheap, but it fit her needs perfectly. It would give her a lot of freedom that she had been missing.
For example, having a conversation with someone. People have a nasty habit of just looming over you when you are in a chair. She can't tilt her head back. Or they would stand off to the side a bit. She can't turn her head much.
She'd have to ask the person to either move around in front of her or turn her chair, and she was embarrassed by it. (If ever you interact with someone in a wheelchair, put your face on their level if at all possible. Don't squat in front of them, but pull up a chair if you can.)
So she was getting increasingly isolated, didn't want to go to social gatherings. She felt bad that my dad had to be at her side to move her around the room or turn her to face the conversation.h
He does *literally* everything for her, and she hated that he couldn't go socialize without worrying about her.
This chair would be perfect.
So we start the process. We get a doctor to sign off on it. We submit the paperwork and wait. A MONTH later we are contacted and told that they need her complete medical history. ALL OF IT.
So we start the process. We get a doctor to sign off on it. We submit the paperwork and wait. A MONTH later we are contacted and told that they need her complete medical history. ALL OF IT.
We spend days on the phone with doctor's offices in three states and covering a span of about 30 years, back to when she was first diagnosed.
After finally gathering all of that we had almost 400 pages of notes, lab test results, MRI results, etc. We make copies of everything and send it off.
About a month later (after numerous calls and inquiries) they tell us they need to do an in-home evaluation to make their determination. We're thinking this is a slam dunk. If you watched what my dad has to go through to care for my mom it would blow your mind.
They come and do the evaluation. I think my mom made the mistake of having my dad put her in her chair. (By the way, he had to dead lift her to do this.) But she didn't want to do the interview from bed, which is understandable.
A few more weeks go by. Then we finally receive word that the claim is denied because it is NOT MEDICALLY NECESSARY. There is an appeals process, which we start. They want all of the medical records again. HIPAA laws prevent those records from being transferred between depts.
So we make copies again. We send it all in again and wait. They come out and do another in home visit. They call a week later to say that the doctor's recommendation is no good, because they only consider it up to date if it is issued within the last 3 months.
We get the doctor's authorization and send it in. But they've closed the claim and disposed of the records we sent in. Have to open a new claim. We make copies, send it in, do the in home interview. Claim denied. Go to appeals, send in copies, do the interview. Claim denied.
Finally my dad just says ..|., to them and pulls money out of his IRA (which is what having Medicare was supposed to prevent) and pays for the chair. This was a year and a half after starting the original claim.
The chair is awesome, by the way. She's so much happier now that she has the freedom to move around the house without having to ask for help. They go for walks (well, my dad walks; my mom rolls), go to movies, etc. It has immensely improved her quality of life.
PS: They also paid out of pocket for a lift to get my mom in and out of bed, as my dad is 75 and can no longer lift her. As soon as they said they wanted medical records and an in-home visit he hung up.
That's Medicare.
That's Medicare.
And don't get me started on working through that hellscape after my dad's heart attack. It is an utter clown show. My brother and his wife live nearby, and they are absolute saints, helping my dad navigate that shit show.
If you want the quality of health care to go through the floor, let the government run it.
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