Saturday, October 12, 2013

Our very own biggest insurance fraud fiasco ever

Lou Ryan is his stage name, but here I am referring to him as Lucas, because that is what people actually call him. He's been suffering for over a year with a debilitating spinal injury sustained on the job, yet he has been unable to get the insurance money he has been promised from this job.
` That means, lots of stress and work for us just to keep him healthy -- it seems I am finally losing my mind for real this time!

Since the daily drama has been keeping me holed up in 'defense mode', why don't I write you a nice, semi-coherent overview of the current situation as well as the larger context? Here goes:

Although we've been dealing with the untreated injury from September 2012, this is hardly the first incident where Lucas has been unable to find help for an injury.
` Not only has Lucas never been able to afford health insurance, but jobs that offered him health benefits laid him off without explanation just before he was due to receive them.
` There were years when he was unable to lay down in bed each night, so instead he would sit on the couch with a bottle of champagne and some movies on VHS in order to distract himself from the pain.
` During the day, he still managed to be an excellent teacher of karate and gymnastics, and he had the same hard work and discipline in construction jobs as well.

Some years ago, he fought with Community Health for six months over whether the searing pain in his knee should be investigated.
` The CH people told him that it was normal for guys in their late 20s to experience such high levels of pain, until finally they agreed to X-ray his knee.
` The tear in his meniscus was so enormous that even the X-ray tech was shocked to be able to see it. Even more astonishingly, Lucas was able to walk on this knee!
` Although this pain tolerance comes in handy, it is also part of what fools doctors into thinking he is in better condition than he actually is.

Although I will talk about the 2012 injury ER visit, momentarily, I'd like to mention that the first time I've written about taking Lucas to the emergency room was several years ago, when his muscles were so locked up that he couldn't walk.
` This was a condition he used to suffer from every few months, and the only treatment that worked was taking a few Soma and massaging the rock-hard muscles for many hours on end.
` I had to put his socks and shoes on for him, and help him gradually lurch to the car. At the ER, where a wheelchair was his only realistic option of mobility, Lucas was perfectly pleasant and explained carefully to the doctor what his symptoms were.
` Still, the doctor refused to give him the only medication that worked on this level of pain and tension. Why? Because Lucas was unable to get a doctor, even at Community Health.
` Rather than essentially letting them push his wheelchair to the door and tip him out onto the sidewalk, he started bitching them out on wheels until the head nurse finally agreed to give him an injection of strong narcotics.
` I rolled my eyes when she said "When I come back, you're going to think I'm your best friend." Evidently, she pictured him slumped and drooling like someone who didn't need the injection. Instead, her eyes bugged when she returned to see Lucas standing up and stretching out his legs.

He walked normally out of the ER because he got the right treatment, even though it was given on the assumption that he was a junkie. All because this man, who is one of the over-the-top hardest-working and driven people I have known, has never been able to get health insurance.
` And it got worse in 2012, while working construction on the U.S.S. Nimitz. Picking up a heavy bucket while at work on the U.S.S. Nimitz, he unknowingly destroyed some of his spinal discs and surrounding structures.
` Later that night, I woke up in the middle of the night to find him collapsed on the floor, sweating profusely, dry-heaving and unable to catch his breath.
` I stayed with him all night in the Emergency Room, where they eventually found the symptoms were a result of chemicals which flood the body after a serious injury.
` They were able to stop his kidneys from being damaged by the proteins, but they didn't actually examine him closely enough to understand the nature of his injury.

The follow-up doctor was apparently the same one who had told him that nothing was wrong with his knee years ago! This time, she would not acknowledge the symptoms from his back injury that led to his being in an ambulance.
 ` The second doctor did acknowledge his symptoms, then conceded that the injury was too severe for him to treat, and released Lucas -- with a clean bill of health! 

Since his injury had apparently just disappeared, the insurance company refused to acknowledge it and thus he has been blocked from opening a claim ever since.

Soon after the injury, my way of life involved the drama of having to care for him when he couldn't walk and him negotiating over the phone with the insurance company. This often involved him begging with increasing desperation over the phone.
` He would talk about his early background of sports like hockey, working his way up to a black belt in Goji-Ryu under Master Chinen, etc. and how debilitated he has become, having to stay reclined most of the time or else be forced to go to the ER.
` Although we were often broke, he had to pay for physical therapy and massage out of pocket just to be able to walk. At first, his injury, as well as past untreated injuries, were so severe that he had to temporarily stop his daily rehab exercises and stretches until his body un-twisted enough.
` His case manager with the insurance company did everything she could do in order to keep him from filing a claim, including not answering her phone for the first six months.
` She also made sure that each time he went to get the necessary out-of-pocket treatment, that the same injury was listed as a new injury each month, and thus a separate insurance claim each time.

The death of Lucas' mother soon after the injury and then his moving a lot of her stuff (and cats) out of the house, trucking much of it north for 13 hours, also took a toll on both him and the injury.
` At least, we thought, we will get some inheritance money out of this so we can send him to a specialist. I even planned to use this money to register for The Amazing Meeting and buy a portable voice recorder for conducting podcast interviews there.
` While I did manage to get to TAM, we still haven't gotten the money, partly because one of Lucas' brothers refuses to sign a form, claiming that he hasn't been able to make it to the bank for the past six months -- not even to finance building his new house!

In the midst of all this, Lucas collapsed at Hempfest this August because he spent too much time with his head above the injury. Of course, it took me a couple of hours to find the hospital, as the street leading to it was blocked off and my cell phone service was off because we had been unable to pay the bill.

` When I visited him in the hospital, Lucas kept going in and out of consciousness, and was covered in blankets soaked with sweat and vomit. He was shivering and asking for them to clean him up and put some dry blankets on him, but that was not allowed.
` At last, he passed out and I could not wake him up, so I wrote him a note telling him the work I was going to do for him that evening and propped it up by the bedside table. I asked the nurse watching him to make sure he got the note -- although Lucas told me later, "What note?"
` I needed to take care of some of his things at home at that time, so I did that and tried to pay my cell phone bill, but the automated system was "closed".
` Huh?
` Figuring that he would not be well enough to leave the ER for a while, I decided to spend the night near the hospital, and used another cell phone to call and text him several times.
` Since he didn't answer, I figured that he was still passed out, but in fact, the calls didn't get through to his phone until the next day because his cell phone must have shut off as well. I slept a few hours, and managed to pay the phone bill before the sun came up.
` I failed to reach his phone again, so I called the hospital and was shocked to hear that he had been discharged. Where was he? I called Chris, the real star of the Hairy Pothead booth, and he didn't know, either.
` Figuring that he was at home, I drove there as quickly as I could, during which time Lucas had received my texts and phone message and he texted me back, telling me to come home.
` When I got there, he was happy to see me and told me about how he was more or less thrown out of the ER, although he was hardly coherent, and managed to call a cab.
` They had kept asking him if he had taken too much drugs, but he said that in fact, he had taken far less than usual that day. All that Lucas knew at that point was that it had something to do with the injury -- same symptoms as before.

As though things could not get more ridiculous with the insurance company, they did. Lucas finally figured out that his insurance claims manager was blocking him from filing a claim because she was a girl he had spurned back in 1998!

Hell hath no fury like the scorn of some bitch with ego problems!

Now with two lawyers working for him, Lucas discovered that the insurance company was actually the wrong one for workers on Naval ships, so he has now switched to fighting with Maritime Insurance.
` The judge has determined that he should get back pay for the job he was working, as well as pay for the job needed for his back. Of course, his new insurance claims manager insists that there is nothing wrong with him at all and so refuses to open the claim.
` However, Lucas has finally managed to get an X-ray, which shows three discs and four vertebrae that are partly destroyed and noticeably lopsided, whereas the rest of his spinal column is perfectly straight.
` I've seen this X-ray and agree with Lucas that a five year old could diagnose this.

Although he recovered to a pre-Hempfest state, he eventually began to develop other problems, and I had to take him to the Everett walk-in clinic at the advice of one of his lawyers.
` A couple of days later, he was in terrible pain again, with an abnormal heartbeat, and he needed to go to the ER. He insisted on going to the same one that they almost dumped the wheelchair out the door.
` He spent a long time there, had a pleasant enough time with the doctor and nurse treating him, and even got an MRI. No life-threatening injuries were found with the MRI, so they decided to discharge him with not much in the way of pain meds.
` When the staff was changed, and sent him out the door with only two days worth of Percocets, he politely asked the nurse to talk to the doctor that had been treating him.
` The nurse suddenly picked a fight, told the same doctor that Lucas was being a jerk, and called security, who escorted him out the door. And at the same time, I faced a similarly nonsensical rejection from a person, on my phone, so both of our expressions were ones of bewilderment and abandonment.
` I was so incensed by those people in the ER that I actually announced this on Facebook. I haven't been logging much time there, partly from forgetting about life outside of this constant drama. And it's even worse than it sounds:

Not only am I frustrated, but Lucas has taken out a lot of frustration on me, and his rationality has been failing at times. I remember he had me go outside and carry a large ladder over some obstacles and into the house in order to change a light bulb.
` I had offered to use a chair, but he said that the ceiling was too high in that room. I estimated that it was not. When I got the ladder set up indoors, I found that I only needed to go as high as the first rung, which was lower than standing on the chair would have been.
` In general, his brain not working right has been affecting the way he interacts with other people, including business.
` Meanwhile, I have been reduced to apologizing and cringing whenever his back acts up, and feel as though I don't know him anymore.

[Edit: The reason for this is because he has a neurodegenerative disorder, not because he's gone insane, as I had thought previously. It is now being dealt with, and it seems that he is able to keep it together once more.]
Lately, he has managed to be referred to an amazing pain specialist and Doctor of the Year, Dr. Olson, which involved pulling hundreds of dollars out of his ass just to see. As a result, he's been prescribed pain meds that meet his needs.
` Also meeting his needs is the massive quantities of painkilling cannabis products, which Olson not only allows, but grants medical marijuana cards to people who need them.
` Interestingly, the pain specialist in the next office over will reject patients if cannabinoids turn up on their urine test, yet he has no problem dispensing such toxic pain relief as methadone.)

The pain meds are working well with the cannabis, and as long as he's out of pain, he doesn't yell at me for no reason, nor make irrational requests. Big relief for Spoony!
` So not only has this delay caused further health and financial damage, but the injury has indirectly led to much emotional damage for me -- it triggers my lifetime store of traumatic memories and damaging thought processes.
`It's hard not to be affected by it, when someone is loudly insisting that you messed up and staying calm only makes him more angry. Although he has apologized for all of this, it does not change the fact that my ability to focus on my own life has suffered heavily.

I think that's about as much as I can rant about that topic -- now for something more light-hearted:

I would like to thank the conservatives at the Heritage Foundation for formulating a certain health care bill in 1989, and who tried to get it implemented during the Clinton administration -- even Governor Romney applied it in Michigan.
` I would also like to berate many of those same people for later opposing the same bill when president Obama proposed to use it. And let's not forget the Tea Party loons, who have successfully "shut down the government" to prevent this service from being carried out.
` I'm sure this won't last long, due to its crippling absurdity. Even so, the government server has overloaded from people signing up for so-called "Obamacare", thus delaying Lucas' ability to benefit from it.

If anybody reading this thinks that Lucas would be denied health care under Obamacare even more than he is now, I'd like to tell that person in advance to fuck off. Jussayin'.

Also, anyone else who says that Jesus would not want him to have health care because he didn't earn it, needs to pull their head out of their ass long enough to read the New Testament, which they profess so much faith in.

I'm not even being facetious -- I have heard working-class people and single moms voice such opinions, even though they are the ones who benefit most from it.

Come on, 2014!

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