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I am a below knee amputee. More importantly, I am also Mommy to two boys, a very active 10 year old (Robby) and an mischievous toddler (Timmy). I have learned that being a parent with a disability can create some unusual and sometimes humorous situations. This blogger is available for hire! Let's talk and learn how a blog can expand your business.

Tuesday, August 25, 2009

Elsie strikes again!

I feel compelled to revisit the topic of a previous blog. I apologize if I am redundant, but I continue to be frustrated by my insurance adjuster. I know that I am not alone in my struggles with dealing with a insurance companies. Talking with other amputees, I know that this is a common complaint and, unfortunately, a struggle which binds many of us together.

I have tolerated delays in treatment due to indecision, shifted through reams of red tape and had to resort to court to receive prosthetic devices. My experiences affirm my believe that there must be a special ring in hell reserved for these paper pushing, heartless, incompetent individuals who have been given the authority to oversee my medical care.

Elsie (I changed the name to protect her anonymity, although I'm not sure she deserves the courtesy) has been my assigned workers compensation insurance adjuster for nearly 3 years. I was optimistic when she was assigned to oversee my claim. She is also an amputee and I assumed that she would understand the needs for a below knee amputee.

I am ashamed that Elsie is a part of the amputee community. Claims for liners, a standard prosthetic accessory, continue to be delayed. She was initially contacted in February concerning my request for new liners. Although the claim was approved, payment has yet to be rendered. It is now July. If I received a bill in February and had yet to pay it in August, I am sure that bill collectors would be calling throughout the day. Ignoring bills through inaction are tolerated because Elsie works for the insurance company. This is unacceptable!

I have called Elsie numerous times concerning my claim. My calls have been ignored. Every time I call I receive her voice mail. She does not even answer her phone during office hours! Finally, only when I questioned the legality of her denying my liner claim, she responded to my request for a return phone call.

I was shocked when Elsie called me. She was polite and efficient, but her demeanor was lacking warmth and compassion. What transpired during my first voice conversation with Elsie? She lied! I was informed, in a very matter of fact manner, that the liners were not requested until May.

I knew immediately that Elsie was being dishonest, but I allowed her to speak. I was with my Prosthetist on more than one occasion when he faxed and phoned her concerning the liners. I knew that I had called at least twice in March to check on the progress of the request.

I am disturbed on several levels. First, she has demonstrated incompetence by not processing claims. Second, and perhaps the biggest cause of concern, is that she has proven to be dishonest. I want to know, does she tolerate such inaction, incompetence and dishonesty from her insurance adjuster?

Dealing with Elsie has become an exercise in patience. I would love to have a dedicated leg for running. I was training for a triathalon in the fall before I was sidelined by illness. Running on my flex-foot has started to cause back pain and sore hips. I hesitate to voice my request because I know that the request will lead to a battle with Elsie.

I am lucky because I have a prosthetist who is willing to fight on my behalf. Despite his efforts, Elsie's stonewalling becomes draining. My prosthetist should not have to battle the insurance adjuster to secure my devices. I am embarrassed that he has yet to be paid. I wonder if Elsie's prosthetist has to fight for her? Wouldn't it be ironic if she denied one of his patient's claims?

I apologize for revisiting this topic. Unfortunately, the situation has yet to be rectified. I am discouraged that this is battle that I will need to fight for the rest of my life. Sometimes I feel that the most disabling force in my life is not my amputation but the fact that I have to deal with the insurance company!

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