My Personal Journey With A Broken System

For anyone who has been through serious health problems, you understand the battles you undertake with insurance companies and the seemingly endless financial burden. A single night in the hospital, with insurance, can still cost you $20,000. You can make small payments on medical bills like $5 a month, but between the interest and fees for every month you pay $5 they tack on $105 more. And despite efforts to make healthcare affordable, prices seem to just continue to rise and rise and rise, with no end in sight. The stress from all these bills and battles is enough to make you sick, which causes more medical bills. It's a never ending, vicious cycle.
I have been fortunate enough to have fairly good luck with my medical insurance company, however, my long term disability insurance is a whole other story. There are quite a few dirty little tricks they play so they can deny you coverage. One trick is asking you what your planned return to work date is and then as soon as that day rolls around they stop your coverage. When I initially took a leave of absence it was for two weeks. Naturally, they weren't happy when the two weeks turned into a few months and eventually a couple years. They first denied me coverage two months after I began my leave of absence. I had to write a very firmly worded appeal letter and was eventually approved and paid for the few months they cut off my benefits. I quickly learned never to give a specific return to work date since doctors were unsure of why I was so sick and I was looking at a minimum of two surgeries and a hospitalization.
I made it through the next few months fairly uneventfully, until around May 2011. At this point I had already transferred from short term disability to long term disability. The insurance company was requesting an in home meeting to evaluate my condition in person. Upon research, I discovered why they do these interviews...they want to come into your home so they can see how you live. An example I found, is if you state you cannot walk without assistance they will sit at your kitchen table and politely ask you for a glass of water. If you get up from the table without your cane or walker they will state that you can walk without assistance and deny you coverage, even if you take just two steps from the table to the sink. They will also ask to take your picture during the interview. This is to give to private investigators who are paid to follow you to prove you are doing something against your disability claim so they can deny coverage. I was advised they will follow you a few days before, the day of, and a few days after your interview. They will also ask you the same question over and over again, in different ways, to try and trip you up and then "catch you in a lie" to deny your coverage. The whole thing is sneaky and abhorrent. It's absolutely disgusting and perfectly legal.
When I heard my insurance company wanted to do this interview and they wanted to schedule it as soon as possible, sirens went off in my head. This didn't sit right with me since I had never heard of an insurance company making this type of request. I didn't return their call right away and instead made a few calls of my own, and did some research. My doctors had never heard of this either, but I found many websites with people, especially people with my insurance company, getting the same requests. I read stories of people being denied coverage for not using a cane to go to the mailbox, people having to call the police to have the "interviewers" removed from the property because they were denied entrance into the home and subsequently started banging on doors and windows, people being watched and followed on a regular basis, all in an attempt to deny them coverage. Most of the people had stated they found out later their policy did not even require them to do the interview. Many also found out, after they were pressured into it, that legally the company must provide you with thirty days written notice of the interview.
Upon being enlightened about the sneaky, not so honorable practices, of my insurance company I called the company back and said that before I could schedule the interview I needed to see a copy of my policy stating the interview is required. They told me it wouldn't say it in those exact words, so when I received my policy and it stated it, in those exact words I was EXTREMELY hesitant. In the mean time, the "interviewer" was calling me daily asking to schedule the interview. I told her that I was waiting for a copy of my policy, and that upon reading that, and consulting with an attorney I would then go forward, if it was required of me. I later heard from the representative in charge of my case who stated that I was not allowed to wait, that I was lying when I said I had to wait for the policy. Luckily for me, I recorded all my conversations with them and informed them that they were the liars and I had a digital copy of the conversation that I would be happy to email to him to help refresh his memory. He never accused me of lying again, that's for sure!
After receiving the policy and being hesitant about the wording, I called my former employer, since they also have a copy on file in Human Resources, and had them send me a copy. After reviewing the copy from my employer, I realized I was supposed to submit to the interview. I sent a letter to the insurance company stating that I was to have an attorney review the policy and that I did not appreciate them accusing me of lying and of them trying to force me into the interview without proper consent. I also informed them that they had to provide me with thirty days written notice of the agreed upon date, and that it was illegal for them to push me for an interview. That letter was sent about ten months ago, I have not heard another word on the subject, and have not had to submit to an interview. In the meantime, this was the straw that broke the camels back in which I finally decided that I could not go on fighting the insurance company...so I hired an attorney and applied for social security disability.
If you find an insurance company wanting to do a "field visit," as they call it, let me give you some advice.
One: Make sure it states in your policy that it is required. If it is not required politely decline, and that's that.
Two: If you are required to give the interview do not allow them into your home. Arrange the meeting at a neutral third party location like McDonald's, or even your doctor's office. You are more comfortable at home, and therefore more willing to let things slip that can be used against you.
Three: Take someone with you to the interview. If you can, bring an attorney, if not bring a close friend of family member.
Four: Openly record the conversation. Buy a digital recorder, introduce everyone present and state the date, location and time of the interview.
Five: If they ask to take your picture, politely decline. If they ask to see identification require they show you theirs first.
Six: Request all questions they are going to ask you in advance. If they ask a question not previously provided to you simply reply "I'm sorry that was not on the list of questions provided to me." If they are asking information they have already or have already asked, inform them they just asked that question and refer to the answer previously given.
Seven: Agree to a specific amount of time. No more than 30-45 minutes. When time is up thank them and promptly leave.
Eight: Always correspond with the insurance company in writing. In this day in age, it is perfectly acceptable to require all correspondence be in writing. It is in the best interest of everyone involved. If you must speak with them over the phone record EVERY phone call. You can check the laws in your state, but most states it is legal as long as one person in the conversation is aware they are being recorded!
In these situations knowledge is power. If you are well informed they can't harass or bully you into hanging yourself. It's not an easy battle, nor is it right they are allowed to do it. It's unfair, disgusting, ridiculous, frustrating, and morally and ethically wrong. I don't know how those people sleep at night or look at themselves in the mirror. Unfortunately though, it is completely legal!
Miracle of all miracles on December 23rd, my initial application for Social Security Disability was approved! At that time, they informed me that they determined I became disabled on April 23, 2010 therefore I would be paid a sum of all the benefits dating from April 2010 to December 2011. Now, because I was collecting long term disability payments during that time I would have to pay back the "over payment" to the insurance company. (If this doesn't make sense to you let me try to clarify: instead of receiving Social Security from April 2010 to December 2011 I received payments from the insurance company. Since Social Security is sending a back pay check for that time I have to pay the insurance company back for what they paid me.)
Upon receiving award notification from Social Security I was advised by my insurance company that I had until February 25th to pay them back what I owed them. At the same time, I was advised by Social Security that my case was under a review board, they would reach a decision by March 30th and then they would pay the money out directly to any other agency or company owed that money i.e.: insurance companies and Worker's Compensation. I informed the insurance company of this, the February 25th deadline came and went and nothing happened. A few days later I received another notice in the mail with a new deadline requiring my repayment to the insurance company. This date was also before the March 30th deadline. I advised them again of the Social Security deadline, but when my check came for my March benefits there was a note where my check should have been basically stating they are cutting all benefits until they receive the money that is due to them. The same day, I receive notice from Social Security that the review board needed clarification on my account. When filing my initial application, the legal assistant who submitted my application had accidentally checked a box stating I was also filing for Worker’s Compensation. Before the final submission of the application the error was found and corrected. However, just to cover themselves, Social Security was then sending me an affidavit to confirm that I was not filing, nor did I have the right to file, for Worker’s Compensation. Due to this discrepancy there was a delay in processing the payment and the March 30th deadline would be extended.

I had tried for nearly two weeks to inform my insurance company of the extended deadline, but the one person in the entire company everyone seemed to think was the only person able to help me, was out of the office. (Where can I get that job? One that you’re out of the office almost everyday? That’s probably a better deal that collecting disability!) I decided before trying again I would call Social Security to get an update from them. When I finally got through and asked for the update I was placed on about a five minute hold. When the man came back on the phone he stated no money had been paid out yet, but that the review board determined I have a student loan that is now with the US Department of Education, and that since I technically owe the Federal Government money they will deduct that before paying out any of the Social Security. (To try and explain: my student loan was with a certain bank, I consolidated it with my other student loan with a loan company. Not long after the consolidation the government bailed out the loan company thus my loan was transferred to the US Department of Education. They promptly sold the loan back to the bank, which within the last sixty days has sold it back to the US Department of Education. I was under forbearance with the bank, and the loan company. To date, the US Department of Education was demanding a monthly payment which is literally 2/3 of my monthly income and informed me any lesser payments would be denied, so we were still working on an agreement.) So, when all is said and done, my student loan would be paid in full, the remainder of the money would be sent to the insurance company, leaving me with no check and a new debt to my insurance company of over $9,000.

With that news in hand I got a call back from the insurance company and they were a little too polite when she informed me that they can’t demand money from me that I do not have and starting with April, my benefits would be reinstated, and the benefits previously denied would be deducted from the amount I owe them. I don’t know why it took me telling them four times that I hadn’t seen any money from Social Security for it to sink in that I can’t give them money I don’t have. Despite a huge company, with probably thousands of employees, this one woman apparently is the only one who could assist in this problem…

I am not 100% what happens from this point on. I am making phone calls and am meeting with an attorney in a few days to discuss what my options are. This whole thing is a disaster and more importantly, a full time job. Our system is so messed up that dealing with it is enough to give even the healthiest person high blood pressure. For a system that is supposed to help people manage their health when they have no other options they seem to be doing more to make me sick from the stress than actually helping. The same goes with people working with you on paying down medical bills. They bully and harass you and handout so many fees. At this point I am sitting here with debt which adds up to more money than I will make in the next two years, and it just gets worse and worse. The system seems designed to keep you in this rut for good. I have had many people, my attorney included, say that at this point bankruptcy is my best option. I haven’t been able to bring myself to do it. I don’t like the idea of wiggling out of my obligations. I know that’s not the case, and have heard over and over again that bankruptcy was meant for people like me, in situations like mine. It’s not like I am sitting here with $50,000 of credit card debt! (Which for the record I have $0 credit card debt!) I went through the same thing before applying for disability, not wanting to be someone sitting around on my rear collecting a government check the rest of my life. But again that was set up for people like me, people in situations like mine. All I can say is the whole process is a huge, stressful disaster that can push even the most well grounded person over the edge! And I am at that edge, hanging on for dear life!

This is NOT a Fad Diet!

I touched on a gluten free diet not being just a diet but a lifestyle change a few weeks ago. Despite that post I feel I have more to say on the topic, and this being my page, and having the ability to write about whatever my little heart desires I am going to write about it again...

Since starting this blog I have been experimenting with recipes again, which has led to more and more people casually stating they too should try a gluten free diet. I am not trying to discourage anyone from trying a gluten free diet. In fact, the more people that go gluten free the easier and cheaper my food options become. However, I have come to the realization in the last few weeks that going gluten free has become a fad. A fad like those awesome stripped toe socks I wore in high school with my flip flops and tennis skirt! Gluten free being a fad is not only extremely irritating but can potentially make all the progress we have made in more widely available food options obsolete. Call me paranoid but I have nightmares that the "ease" (I use that term quite loosely) of attaining gluten free foods will cease to exist and we'll be thrust back into a world of eating cardboard and plywood!

As the saying goes "just because you're paranoid, doesn't mean someone isn't out to get you!" There are a number of examples of fad diets and even allergies that have lost their "popularity" and faded from our minds. A few years ago you couldn’t find a peanut on an airplane and the "South Beach Diet" stamp was on foods up and down the grocery aisle. It's just in the last year or so that people have started giving up on their "no high fructose corn syrup" diets. Everything from vegan-ism to the Atkin's diet eventually fades from the mainstream leaving behind the few faithful followers. If gluten free diets are in fact becoming a fad, it will leave patients with Celiac Disease as the final faithful followers. It will be like going back to technology that was popular in the early 90's.

The only idea I have to counteract this potential assault on how "easy" (again, using the term very loosely) my diet has become is to educate as many people as I can about the diet. So much so that I am starting to sound like a broken record standing on a soap box. I think all gluten free dieters, at least the serious ones, need to band together to make sure we aren't taking one step forward before we take three steps back. You can do this by doing things, like calling Lays and informing them that your (or my) favorite barbeque potato chips are now off limits because they changed their recipe to add barley malt, or supporting company's that change a simple ingredient so a product is gluten free, like Chex cereals. We are the consumers and if we raise enough of a commotion companies will listen. After all, they are in the business of making money! Another important step is discussing with stores about stocking more gluten free options. If you're willing to buy it, most places will try to sell it to you.

Going beyond contacting retailers and manufacturers, educating the public who fall for fad diets is also really important. I don't know how many times people have said to me "hey, I was thinking about trying a gluten free diet." I can't help but think that 99% of the time they are not serious, simply jumping on the rice cracker and tapioca starched bandwagon. There appears to be this vast misconception that cutting gluten from your diet it like cutting fat, calories, sugar, high fructose corn syrup, caffeine, fast food, carbohydrates, and dog food. Okay, maybe not so much the dog food! Still, I cannot stress it enough GLUTEN FREE IS NOT A DIET IT'S A LIFESTYLE!!!

Two of my favorite books regarding Celiac and gluten free diets are Living Gluten Free for Dummies by Danna Korn and Wheat Belly by Dr. William Davis. They both address various medical conditions that can, and have been treated by going on a full gluten free diet. Everything from autism, diabetes, heart disease and rheumatoid arthritis. In some cases, patients not only lost tens to hundreds of pounds, but showed an incredible amount of improvement in their overall health by being able to stop taking certain medications. In rare cases, a few people have even been essentially cured of their ailment. The key to the success, as pointed out by both authors, is a complete dedication to going gluten free. That doesn't mean cutting back on how much Wonder Bread and Twinkies you eat, it's a full commitment. All or nothing.

For some reason, that is the key that seems to be missed by most people without a direct medical problem requiring a gluten free diet. They seem to think they can cut out half of the gluten in their diet, or not eat gluten on Thursdays and Sundays between 12:00 am and 3:57 pm. I like to look at it this way: if something is poisoning your body, if it is preventing your body from functioning properly and causing you pain, weight gain, and a host of other problems, then don't you want to give it completely up? You wouldn't realize you're stomach problems and hair loss are from the arsenic in your morning coffee and keep putting it in the coffee. And if something is poisoning your body, how will you truly know without removing it from the diet? Unfortunately, today's medical technology does not allow testing for a gluten sensitivity or intolerance, it is done largely by trial and error. You cannot do trial and error if you don't do a proper trial!

I realize that there is a lot of hesitation in embarking on a gluten free lifestyle. When I began mine, I had little cartoon pizzas and doughnuts circling the top of my head. It's a momentous undertaking and gluten items will pop out at you at every corner disguised as over the counter medications and chicken gravy. But embarking on such a lifestyle cannot only change your life, but prolong it! You can feel better, have more energy and be more active all by cutting out that pesky little protein. If you are faithful and diligent on a gluten free diet and still feel tired, or have high blood sugar, or are struggling with weight loss and you want your fried chicken and artificial bacon bits back I won't stand in your way. But like the cliche says if something is worth doing, it's worth doing 100%.

Perhaps I shouldn't take the gluten free fad as an insult, but I do. I see it as making a mockery of my lifestyle. I would still encourage anyone who wants to see if it will help them. But if you're going to do it, do it right!