TING AND I: Medical Insurance Experience

HANCOCK LONG-TERM CARE INSURANCE, 1995– 2009

During my IBM employment, the John Hancock Insurance Company got IBM to allow them to offer a special deal for the IBM employees to obtain long-term care insurance. The options had fixed total payouts, with the middle option that we chose being a total of $210,000, several times my annual salary at that time. They could not deny participation due to prior medical conditions, and we were open about Tina’s multiple sclerosis, the symptoms of which were mild back then.

Five or ten years later, when we met the disability requirements to qualify for weekly supplementation of our home health aide’s salary, Hancock started paying about $250 per week to reimburse us. This went on for fourteen years, paying about half to two-thirds of the cost of our aides, who typically worked a thirty-hour to forty-hour week.

Thank you, John Hancock.

*****

　

　

EMPIRE BLUE CROSS / BLUE SHIELD, 1983– 2004

During the 100-days’ war against Tina’s aspiration-caused pneumonia, from February to June 2004, we ran up roughly a half-million dollars in hospital expenses, covered by IBM’s policy with Empire Blue Cross/Blue Shield of New York State. When she returned home, round-the-clock skilled nursing was similarly covered, without a problem by Empire BC/BS, whether the billing came from the nursing agency or from me.

Thank you, Empire Blue Cross / Blue Shield.

INSURANCE BLUES: MVP, 2005

One must sometimes fight one’s insurers.

At the start of 2005 we were moved by IBM from Empire to MVP. The early section on Tina’s choice to live has already described some of the 100-day struggle that was fought mainly in the Critical Care Unit. More details in Terry Bush’s piece in the Tributes section below.

MVP wanted more documentation than Empire had required. We sent them reams.

MVP wanted to stop paying for the skilled nursing at home, labeling Tina’s need as “custodial care” rather than “skilled nursing care.” Custodial care is roughly equivalent to babysitting, which would include giving bottles and making diaper changes. Tina was on a ventilator, fed through a gastric tube, quadriplegic, and in pain if morphine were not given in proper amounts at proper times. There were about a half-dozen prescription medications to be given at various times during the day and night. The gastric tube needed daily care. The tracheostomy needed daily care.

All activities needed to be documented, to assure they were done, to provide continuity of care from shift to shift. We had hospital orders for all this, along with a doctor’s orders as well. Still, MVP carped. They planned to stop paying for daytime skilled nursing care. They refused to pay for overnight care.

From 10:00 p.m. to 8:00 a.m., through all of 2005, I was the overnight nurse, resting beside Tina, getting up for the administration of medicines, answering overpressure or underpressure alarms from the ventilator, suctioning secretions from her trachea, changing her disposable diapers by rolling her carefully on the bed while keeping from hurting her tender wrist joints.

I do believe “work is love made real,” and this was a labor of love. The loss of sleep was less a problem than was the fear that I would be alone when we lost electrical power, as we do several times each year here, or when she had an emergency condition requiring my immediate attention and my calling for help simultaneously. Evacuating her from a fire would be terribly difficult alone, too. Walking the dog briefly or checking some questionable condition outside meant abandoning her. Not good, not good.

We appealed the proposed removal of MVP financial support for the daytime nurses, and we pushed for overnight skilled nursing as well. Two levels of MVP reviewers turned us down. Two levels of IBM reviewers turned us down. An independent outside medical review, our last hope, vindicated our position entirely. Yes, one must sometimes fight.

We had started replacing some of the agency nurses as early as August 2004. By January 2005, I believe, we no longer used the agency. We started hiring overnight nurses in January 2006. MVP was slow to pay, getting behind a month or two for much of the year. At $25,000 per month, this created a significant cash-flow problem.

UNITED HEALTHCARE

Next, we were switched by IBM to United Healthcare (UHC), the group we are with now. They were less demanding than MVP, and more helpful; but the transition delayed our reimbursements (we pay the nurses, weekly, ourselves) for two or even three months, amounting to $50,000 to $75,000 in arrears. I fear that few other couples would have had the savings we had that let us cover this shortfall. Eventually, UHC caught up, to our relief.

Thank you, United Healthcare.

THANKS TO IBM

In seven years, IBM has paid more than two million dollars for Tina’s care. My decisions to work for IBM and, ten years later, to take their early-retirement buy-out, paid off for us. We are greatly appreciative. The ten years I worked for IBM proved to be the best working situation I ever had.

We lost one round of the lottery of life by Tina’s being stricken with MS, but we won another round by having IBM’s help, and we won the big jackpot by getting to be married to each other, having been in love since 1963, but apart for nineteen years.

We are, indeed, fortunate.