Insurance Appeal- A Listener's Guide

For the past two years, I have been recording a monthly podcast with my friend and fellow amputee Dave. Dave is a lawyer, but once I learned to overlook his vocation (our joke), I came to realize that he is a really great guy. I have a great respect for his opinions and his expertise. It turns out that having an amputee lawyer friend who specializes in insurance reimbursement can be quite the sounding board, especially when I have to deal with Elsie, my insurance adjustor.

I have grown to thoroughly enjoy recording our podcasts. Although I still do not relish hearing my voice, I am proud of the issues we have discussed. We are by no means professional broadcasters, but we have been able to develop a comfortable rapport during our dialogues. I'd like to think that we sound like two competent friends exchanging ideas rather than "experts" espousing facts and trivia.

As proud as I am of our content, I am fully aware that our product is definitely homespun.  Although it isn't from a lack of trying, Dave and I simply don't possess the audio engineering skills necessary to create a refined result. Because editing the audio is laborious and sometimes downright infuriating, we tend to take a minimalist approach. In other words, the little flips and mistakes which other podcasters remove are unedited in ours.  We prefer to think of the the podcast as organic as opposed to amateurish.

Last week Dave and I began a series dedicated to drafting the perfect insurance appeal. Because this is an issue dear to my heart, I wanted to share the recording. Please forgive the flubs, technical missteps and obvious mistakes.  Enjoy!  http://www.podcastgarden.com/episode/your-insurance-appeal_11464

So many amputees are denied the devices that could help them live more active and fulfilling lives. A denial does not always equate to the end of the line, but is often a hallmark that the battle is just beginning. Dealing with the appeal in the correct manner and providing specific details is often the difference between obtaining the prosthesis and living without it.  We hope that this series will empower the community with the knowledge necessary to win the dreaded but all too common insurance appeal.

No Small Favor!

Yesterday I completely violated my physician's orders to rest and to avoid strenuous activities. Out of an obligation I made to a friend, I was put into a situation where I found myself moving, bending and lifting boxes for hours. As the day wore on I found myself feeling increasingly frustrated. Had I known the true nature of my friend's need, I would have known that I was not in the position to help.

My friend, whom I have been trying to help pack her apartment for the past few months, called me again on Saturday. She explained that she was in the hospital and asked if I could sit in her apartment on Tuesday while the movers worked to put her furniture and boxes into the truck. I asked her if she was packed, and she said that she was indeed ready to move. Although I wasn't entirely thrilled with the prospect of sitting in her apartment all day while boxes were being moved, I knew that she was in a bind. I agreed to oversee the movers.

After a comedy of errors, I finally gained entrance to her secure building and made my way towards her apartment. I was flabbergasted when I stepped inside and realized that nothing has been packed since the last time I had been there to help. The movers were agitated, barking directives for me to clear out the file cabinets, dressers, drawers etc.. I was prepared to spend the day sitting and supervising. I was certainly not prepared to pack the rest of her apartment!

At first I felt overwhelmed. As the hours wore on, and my fatigue increased, I found myself becoming livid. My leg hurt, my back hurt and constantly bending and stooping was both uncomfortable and painful. Obviously she knew that the apartment was not packed, and that she required more assistance than my simply supervising the movers. I feel like I was duped, but I know that explanation is too simple.

My friend has been living with a traumatic brain injury (TBI), rendering her easily distracted and prone to confusion. I would like to attribute her grossly underestimating the scope of the favor to her TBI because I don't want to believe that she deliberately misled me. But believing that her miscommunication was the result of a disability, and not dishonesty, makes me feel guilty for becoming so frustrated and angry.

I don't know if my being misled was a result of her embarrassment and desperation or because of her TBI. I suspect that all factors played a part in the spinning of the request. Regardless, I worked all day and, to my and the movers' astonishment, the apartment was eventually completely packed. 

Today I am going to try to limit my physical activity. Last night I was cramping and uncomfortable. Although it wasn't severe, I intend to heed the warnings and take care of myself. Perhaps for the remainder of my pregnancy, it would be wise to just turn down all favor requests. 

A Good Start

Yesterday was a busy, albeit  extremely productive, day. I was surprised by how much was accomplished considering that Robby was home from school.  After ten consecutive days of his being home, I had all but abandoned aspirations of productivity!

The day started early with my answering emails and putting the finishing touches on an insurance appeal. Just was I was about to fix Robby breakfast and lay down the plans for the afternoon, the telephone rang. On the other end was a young Mom who was faced with an imminent amputation. She was scared, and her fears were intensified because she was concerned about how her four year old son would react and adjust. The conversation didn't take long before I offered to meet her and her son later that morning.

After the plans were set, I explained the situation to Robby. Upon hearing that a child was worried about his Mom being an amputee, my little guy gave me a sheepish grin and a thumbs up. "Don't worry Momom, I've got this. I'll talk to this kid and let him know that having an amputee mommy is awesome. Remember, we don't even have to wait in lines for roller coasters. How cool is that?" 

I was anticipating the habitual whining of having to change out of his pajamas and leave his XBox, but Robby surprised me by his willingness to help. He never uttered a complaint and appeared eager and comfortable meeting this new family. I was proud of his ability to relate and the empathy which he demonstrated to this nervous little boy. After our visit, I had the impression that both the mom and son felt better about the impending amputation.

After meeting with new friends, Robby accompanied me on my visit to teach Abby. He assumed his position on the family couch and quietly played with his IPad throughout the session. Again, he never muttered a complaint and could not have been more delightful. We were definitely on a good behavior roll!

By the time we arrived home Robby had reached his socialization limits. All he wanted to do was play on the computer and decompress for awhile. Since I had to leave for a doctor's appointment and Mr. Bill was going to be watching him, I was happy to accommodate his requests. After his stellar behavior, he had definitely earned some down time!

I'm always nervous before my doctor's appointments, and this one was no different. Despite my own health issues, the baby seems to be developing perfectly. As of yesterday, he (or she) weighs 2 pounds 4 ounces and is extremely active and healthy. I even received a wonderful souvenir from the appointment- our first true photographs! All things considered, it was a very good start to the week.

All Things Lincoln

Two weeks ago in school Robby learned about the assassination of President Lincoln. From the day of his first lesson on the topic, Robby has been enthralled and hungry for all details concerning Abraham Lincoln being "sniped" while he was at the theater. (He is also quick to explain that they used to call it assassination in the "olden days.") Since he was home all last week because of bronchitis and snow, we have had ample time to thoroughly research Abraham Lincoln's untimely death. Not being a history buff myself, I quickly grew weary of the topic. However, his quest for details seemed never ending so I obliged and helped with the research.

A few days ago, Scott surprised us with tickets to tour Ford's Theatre (the place of the "sniping") and the Peterson House (the building in which Lincoln ultimately died). Robby and I spent the weekend brushing up on our Lincoln facts in preparation for our big tour on Sunday. Excited about visiting the actual theater, Robby was the first one up on Sunday morning. It was a big surprised to see his eager little eyes peering at me at 6:00 in the morning, but I was also happy that he was excited to go on the tour. After all, I don't know many seven year olds who wake up early because they want to spend the day at a history museum!

As we were gathering items to take with us, I became increasingly aware that neither Scott nor Robby seemed overly concerned about the bulk and weight of their "necessary items." Of course they didn't care; it was all being crammed into my purse! Because of the tablets, cameras, wallets, bottles of water, and snacks, I was toting an extra 5 pounds on my shoulder.  Between the obscenely heavy purse, the baby weight, and a new foot which is of a higher category (hence stiffer), I was definitely struggling to keep up with the boys as they weaved through the foot traffic to get in line for our tour.  I finally gave up and assumed my position in the rear, knowing that neither could begin the tour without me. After all, somewhere in my abyss of a purse were the tickets. 

Scott and I anticipated being at the museums for 90 minutes. Afterwards, we planned to eat at Lincoln's Waffle House before taking the train to return home. Confident that we would be home no later than 2:00, I had planned on spending the rest of the afternoon cleaning the house. It turns out we had completely underestimated Robby's museum stamina!

Robby thoroughly examined every display. He carefully listened to the narration on our rented audio sets at each exhibit. When he learned something new or particularly interesting, we listened to the audio narration twice. After awhile, Scott and I simply followed in tow as he explored the museums.

I was happy that Robby was comfortable approaching and asking his questions or offering his observations to the Park Ranger tour guides. After a few interactions, the Ranger tried to trip up Robby with some trivia. My little history buff shocked him by providing the correct answers.  (Did you know what John Wilkes Booth's last words were? Apparently Robby knew that Booth uttered "useless, useless" because he was staring at his newly paralyzed hands after being shot in the neck.)

What we thought would only last 90 minutes turned into a four hour Lincoln fact-finding mission. I definitely felt the impact both on my amputation and my pregnancy by the time we caught our train to go home. I was utterly exhausted and acutely aware that my previously normal gait pattern had morphed to an awkward waddle as a result of being on my feet all day.

We never did make it to the Lincoln Waffle House which was the part of our trip I was looking forward to the most. And although I didn't get to enjoy my "legendary waffle," I did get to see Robby absorb history like a little sponge. I have no doubt that he would thoroughly enjoy touring the Manassas Battlefield this summer (it is only 10 minutes from our house), but I also realize that we will be talking about an all day affair when we go. Upon further contemplation, perhaps this would be the perfect experience to share with his Civil War loving friend Mr. Bill!

For my friends wanting to see the baby bump

Snowy Valentine's Day

All told, the snowstorm dumped about 16 inches of fluffy white happiness in our yard. After putting off his pleas to play until after the heaviest bands of snow passed through the area, Robby and I bundled up and set out into the white abyss. The first item on his agenda, shoveling Mr. Bill's walkway, was accomplished in record time. I have to admit I was surprised how quickly he was shoveling, but I suppose the reward of sledding was enough motivation to get the job done.

Scott hopped on the tractor almost as soon as he woke up, anxious to start clearing as much snow as possible. Thankfully, he didn't delay the chore because the depth was nearly too much for the little John Deere to handle. After some trial and error, he was finally able to clear our driveway. As soon as he broke through the imposing mound of snowplow pushed snow, he drove his tractor up the street and freed all of our neighbors. It took him a few hours, but I know that he made everybody happy.

After Mr. Bill's walkway was shoveled, Robby and I spent almost two hours playing outside. Between the pregnancy, the depth of the snow (which made it laborious to try to walk) and my cold, I was barely able to keep up with him. Of course, he had the fun part of sledding (going downhill) while I was stuck with the Sherpa duty of hauling the sled back up the hill.  Although I thoroughly enjoyed my time with him, I was elated when I saw his friend trudging down the street towards our house. I was summarily dismissed to go inside to bake cookies and make hot chocolate almost as soon as his friend arrived. In this situation, I was thrilled to be displaced!

Today both boys are home again from school. I'm sure that Robby will spend much of the afternoon sledding and throwing snowballs. With the plowing done, I fully expect Scott to stay in his Angry Birds fleece lounge pants  as he watches the Olympics all day from the comfort of the couch.  I don't have the heart to throw a kink into his relaxation plans with a reminder that today is Valentine's Day. Unless they mention it during the Olympic coverage, I am not holding my breath on his remembering. 

SNOW DAY- again

After several days of battling bronchitis, Robby turned the corner yesterday. He slept through the night (finally) and woke up quasi-chipper. He was happy that his "old man voice" was leaving and that his throat didn't hurt anymore. Although he was feeling better, I opted to keep him home from school again. I didn't think it was beneficial for him to attend school for one day when, in all probability, classes would be cancelled for the remainder of the week due to snow. 

He spent the day playing XBox, watching cartoons and building rather impressive Lego creations. By lunchtime he was doing so well that I was second guessing my decision to keep him home. Feeling better myself, I was able to get caught up on some paperwork. Once my reports were done, I had enough energy to bake some treats for Valentine's Day.

By 6:00, the relatively light activities of the day had taken their toll on me. While Robby was still playing, I ended up curled on the couch under the electric blankets. The impending storm was wreaking havoc on my limb causing the tissue to swell and making each step painful. Phantom pain, which I thankfully don't experience often, always leaves me frustrated. I guess the constant pain is a reminder of the limb that I'm missing.

Typically I would take a Tylenol PM and go to bed when the pain becomes as severe as it was last night. With my being pregnant, that option was eliminated. Instead I alternated between massage, heat and cursing. Sometimes being a pregnant amputee is miserable, and last night was a prime example!

This morning we woke up to nothing less than a beautiful winter wonderland. We have about six inches so far with a predicted 15 inches by the time the storm ends. Robby could not be happier with the snow windfall, begging to go outside and play as soon as he woke up. At this point, he will never admit that he had been sick; there is a lot of snow outside and he plans on building an igloo and sledding down our hill.

This morning my limb is tender and the nerves are twitching, but the constant pain has lifted. I am not about to let a little tenderness keep me from building in the snow with my favorite little guy.  But he is going to have to wait a little while.  I don't plan on venturing outside until the white out conditions subside.  Until then, it looks like more Scooby Doo on the couch. 

We'll post pictures of our snow creations later!

Sick Day Part 2

Robby is entering this third day on antibiotics and so far he has shown some signs of improvement. His days have been spent lethargically lounging on the couch or half-heartedly playing video games. At night his symptoms become more severe with the near constant coughing causing his throat to hurt.  I have tried to ease his symptoms and make him comfortable, but I know that we just need to wait it out until the medication kicks in, and his body begins to fight the infection.

As luck would have it, I have come down with a cold. My energy was completely zapped, although at this point it is impossible to tell if I am depleted from the pregnancy, stress, insomnia from taking care of Robby or my own virus. Regardless of the causes, I spent much of yesterday afternoon curled next to Robby on the couch, napping.  I guess my body finally decided that I needed to slow down!

Thankfully Scott was able to take off from work an hour early. Lying down and taking a proper nap, in a real bed instead of a couch, made the world of difference in my energy levels. Although I still feel systemic, I am beginning to see hope that my healthy self might return (someday).

This evening we are expecting a snow storm but I certainly didn't need Accuweather to confirm the impending flurries. My leg has been aching and sore heralding the storm with its usual phantom pain announcements. Trying to find the bright side, I suppose that one bonus of being exhausted is the fact that phantom pain does not keep me awake! 

With everybody lamenting the impending snow totals, I have to admit that I am looking forward to it. From the comfort of my rocking chair positioned next to the wood insert, the snow is beautiful. My being excused from shoveling this year certainly adds to the tranquility!

I also love hearing the squeals of laughter and giggles coming from Robby and his friend as they throw snowballs, sled and build forts.  Hopefully Robby will recover enough to enjoy his predicted snow days. After all, staying home from school because you're sick and having classes cancelled because of snow are two entirely different things.  This is touted as the biggest storm of the year; he would be heartbroken if he isn't well enough to take advantage of the sledding opportunities.