October 19, 2021
On August 20, my husband, Vern, injured his back while working his retail job at Lego Land in Winter Haven, FL. He had to pick up a heavy crate of bottled water in an area too small for him to lift with his legs. He went to an Urgent Care facility. The provider there did not examine him, only gave him a prescription for pain medicine and sent him back to work. Even on the medicines, his pain continued to worsen. He went back to Urgent Care and got different prescriptions and was told to return to work. His pain continued to worsen. Vern was no longer able to work, so he had to take emergency sick days. If he takes too many unplanned days off, he loses his job and his insurance. Within a few days, his pain was so severe that I took him to the Advent Health emergency room in Celebration, Florida, near our neighborhood. He was in the hospital three days. We finally got a doctor’s letter saying he was too sick to work. This at least relieved the stress over possibly losing his job and his health coverage.
While in the hospital, Vern had x-rays, CT scans, and MRI scans. The neurologist on call for the hospital, Roland Torres, reviewed the scans and told my husband: “Your lower back is in bad shape.” For insurance reasons, Vern had to try physical therapy for a few weeks before Dr. Torres could schedule a surgery. Insurance won’t cover back surgery except in emergency situations unless all other options have been tried and failed. Even though Dr. Torres knew Vern needed surgery, Vern had to try therapy first. After a few weeks, the therapist told him the therapy was not helping and possibly making the injury worse. So, we went back to Dr. Torres.
Dr. Torres and his assistant scheduled us for surgery on October 18 but told us they would both be out of town until the day before the surgery. Then the billing nightmares began. Dr. Torres’ assistant, Lynette, told us that Dr. Torres would be in network for Vern’s Aetna insurance plan, but that she would have to gather a lot of information to make sure Aetna approved the surgery. Without that approval, the surgery would be cancelled. Meanwhile, the pain in Vern’s back, and his ability to walk, continued to worsen.
Five days before the surgery, and the day before Lynette and Dr. Torres were going on vacation, we found out that Vern needed a written statement from the physical therapy department stating that the therapy was not working. The notes from the therapists had been sent to Dr. Torres’ office, and forwarded to Aetna, but were not specific enough to satisfy Aetna. We went back to the physical therapy clinic yesterday and got the specific assessment statement we needed. Physical therapy’s billing office graciously took care of faxing the statement to Aetna. Within a few hours, Aetna had approved the surgery,
This morning, four days before the surgery, we found out that even though Dr. Torres is in network for the overall Aetna plan Vern is on, he is out of network for the Merlin Entertainment company’s list of approved providers for their coverage.
Six other doctors in Dr. Torres’ office are in network for Merlin, but Dr. Torres is not. The difference in the amount of deductible, and the percentage of the cost covered for the hospital, the surgery, and other ancillary costs could be over $7,000. In network, it would be significantly less.
I called the neurology office to see if we could transfer Vern’s care to an in-network doctor in the practice. We were told that they don’t routinely do that. We were also told that only Dr. Torres or his assistant, Lynette, could authorize that transfer. They are both out of town until the day of Vern’s scheduled surgery. No one in the office could provide any assistance or refer me to another person to talk to. They wouldn’t even let me talk to any to other scheduler in the office to see how long it would take to get rescheduled for surgery with an in-network doctor, or if that would even be possible.
Since the nerve damage is progressing daily until the surgery is done, we had no choice but to go ahead with the scheduled surgery. We’ll figure out how to cover the extra costs later. With me being on Social Security and Vern making just above minimum wage, this will not be easy. But we will do it.
I don’t care if Universal Healthcare is socialism or not. The system we have now is too confusing and seems designed to destroy the finances of anyone who gets sick. The healthcare system today is not about making people well. It’ about making money off of sick people. America can do better.