About Me

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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.

Friday, August 26, 2011

What Everybody Should Know

A few weeks have passed since I received the paltry offer from my workman's compensation adjustor. I decided to become proactive by coming up with a counter offer that I felt was both fair and justified. My prosthetist and a lawyer friend have been collaborating to develop a spreadsheet detailing the cost of a lifetime of prosthetic care. To say that I am grateful for their help is an understatement!

I was angry when I received the initial offer because it was based upon the assumption that I go onto Medicare. In the offer, funds were being allocated to what is dubbed a "Medicare Set-Aside Account (MSA)" which would be accessed by Medicare to pay for my care and prosthetic supplies. I found this to be absurd because I have health insurance and I am not on Medicare!

I struggled to determine a settlement figure that would assure my access to prosthetic care. In my mind I finally made peace with both a number and the method of allocation that bypassed Medicare completely. Once I formulated a plan, I felt a sense of relief and was able to sleep without waking in a panic from stress and anxiety. I was beginning to feel excited about putting this chapter of my life behind me!

A few days ago I optimistically phoned my lawyer to present my terms. A phone call that began with me smiling abruptly ended with my tears of frustration. In retrospect, a few minutes on Google would have saved me a lot of heartache!

It turns out that Maryland became the first state to adjust their Workman's Compensation laws to mandate that Medicare be utilized by individuals who have suffered long term injuries. The legislators have left me no option but to join the government quagmire to access prosthetic care. The MSA account is required to off-set a portion of the financial burden from the taxpayers albeit the amount is relatively small.

When my claim is settled, I am forced into a government run, taxpayer funded system. On principle, as both a taxpayer and a patient, I find it offensive that my Workman's Compensation insurance company can sit on obscene profits (7.8 million last quarter) while the government is forced (by its own laws) to cover the expenses for my care. Yes, the MSA will help to absorb some of the cost, but it will by no means provide a lifetime of prosthetic care.

Obviously, the insurance lobby is strong in Maryland. In the Legislators infinite wisdom, they have forced an already financially strapped government program to pay for care, allowing insurers to abdicate their responsibilities. I resent being put into the Medicare system so that the insurance company can avoid paying their bills!

Currently I am fighting to have the MSA increased, although my motivation is probably more vengeful at this juncture. When my Medicare slush fund is depleted, a combination of Medicare and my health insurance will pick up the responsibility.

I am trying to accept the fact that I am strong-armed into the Medicare system. My goal now is to increase my MSA account to accurately predict my future prosthetic care. Much to the chagrin of my adjustor, I don't plan on spending my life reliant upon a wheelchair, even if it is cheaper than a leg!


  1. we have to use Medicare because of my son's adoption. It is a pain in the but--every year we have to go through hoops to prove he has grown in a year... and from what I've heard they are almost a year behind on payment to the prosthetic office.

  2. I was forced into medicare as a disabled spouse of a (then) active duty military man. Getting Medicare to pay for things is extremely difficult and they recently changed the rules on the one nondrug treatment that helps me! I need radio frequency ablation in 4 areas (both sides of lower back and both sides of sacrum/SI joint), with it I get great pain control and enjoy a much more active life. However I am not allowed only 1 procedure per year, and doing just one spot doesn't help enough to warrant the 5K cost. This has forced me to have to rely on medications, which thanks to living in Florida I can't have an effective amount anyway, which has made me bedridden 90% of the time.

    Insurance is INSANE!