Entitled to doesn’t mean approved for

A wonderful comedian, Steven Wright, has a bit that goes something like this:

I went to Store 24, but it was closed. The next day I went in and complained to the manager, “You’re supposed to be open 24 hours!” He said, “Yeah, but not in a row.”

Dealing with my father’s recent illness has been a little like that. It started in the hospital when the neurologist in charge of my father’s case, an expert in the illness he had, wanted Dad discharged to New England Rehab where he could get several hours of physical therapy a day and care commensurate with the seriousness of his illness. Doctor Bigshot, who oversees expenses for my father’s primary care provider’s practice said no. We don’t know if the primary care doctor was even consulted; Doctor Bigshot is in charge of the purse strings. When the neurologist heard he was incensed and instructed the hospital social worker to resubmit the request. He was determined to have Dad sent to New England Rehab. Twenty-four hours later, the transfer request was turned down again, by Doctor Bigshot. He wanted Dad sent to a “skilled nursing facility” which would be less expensive, and he was willing to have insurance pay for Dad to spend more days in the hospital while we argued with him.

This time, we (the family) filed a complaint with the insurance company. If the neurologist wanted Dad sent to rehab, then by golly that’s where we wanted him to go, too. After review by one of their own doctors, the insurance company agreed to authorize rehab. Doctor Bigshot overrode the insurance company. The neurologist, who had sworn to fight the good fight on Dad’s behalf, caved. He agreed to release Dad to a nursing home if he was guaranteed at least two hours of physical therapy a day.

Off Dad went to the nursing facility where, as bad luck would have it, Doctor Bigshot himself was in charge of the purse strings. After a month there, even though Doctor Bigshot and the insurance company agreed that Dad needed twenty-four/seven assistance, that he wasn’t strong enough to do much of anything on his own, they decided it was time for Dad to go home. We considered contesting the decision, but we weren’t convinced that the care he was getting couldn’t be duplicated at home, particularly because, according to his insurance, he was entitled to thirty-five hours of home care each week. And once out of the nursing facility we would no longer be subject to Doctor Bigshot’s penchant for parsimony.

We traded Doctor Bigshot for a VNA-like organization that would be responsible for his care at home. We told everyone that we spoke to that we wanted as many home services as we could get, that “Dad’s insurance entitles him to thirty-five hours of home care each week.” It soon became apparent that entitled to wasn’t the same as getting. Each discipline, Physical Therapy, Occupational Therapy and Nursing, would do their own assessment and recommend the appropriate number of visits per week. They explained that their goal was to teach the family how to provide the services to the patient. It only took us a few days to realize that we’d need a whole lot more help than was going to be covered by insurance, even if we could squeeze thirty-five hours a week out of them, which we couldn’t.

If educated people with resources can be brought low by the insanity of our healthcare system, I fear for us all. I have now put healthcare at the top of my list of requirements for any politician who wants my vote. I suggest you do the same.

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5 responses to “Entitled to doesn’t mean approved for

  1. Here, here! Our healthcare system is in deep trouble!
    Feeling for you all in the Mintx family!1!!!

  2. That’s Mintz Family!!!

  3. This story makes me sick to my stomach… Health care is so messed up. Wishing your father a good recovery and your family much strength in providing the care that our country won’t provide, thus burdening families that often don’t have the time because they have to work every day to keep up the health insurance that pays for almost nothing.

  4. Judy, that’s just insane. I’m sorry your family has had to deal with this run around. We’d all like to think we can get the exact right care when we need it.

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