Today ended up being a pretty good day. After hours on the phone, back and forth with Secure Horizons, Magnolia Care Center and Sharp Healthcare, I got his transportation to radiation covered! It is just amazing how you have to work with these companies. I know these people have a job to do, and we are not their only patient, but my goodness, if you don't watch every move, they will do what they please.
It turns out that the case worker with Sharp is the one behind the denial. I do believe this is also the case worker who deemed my Dad "at his maximum potential, therefore no longer at rehab status." Well, when I finally got her on the phone, she was rude and her tone left a lot to be desired. I am still mad at the "long term care" designation, but the real issue now is the transportation. So, I started off with that. I explained who I was, and why I was calling, and that we needed ambulance transportation because my Dad couldn't walk. She came right back at me and said that she was familiar with my Dad because she had been dealing with him back at Arbor Hills. Then she says (and this is the kicker) "he can walk." Oh yah, it was on now...This just set me off. We went back and forth, and she said that because he was in custodial care, the transportation was not covered. Well, I lit into her saying that my Dad cannot walk and he needs an ambulance, and that whoever made the designation to send him to custodial care has severely impeded him, because he is not receiving any physical therapy, which is in turn making him weaker, which means he will continue to need ambulance transportation...I said that this has created a big vicious circle that started when someone made the decision that he had reached his "maximum potential." She came back and said that it is not covered, and I told her that Secure Horizons told me it was. She said she would have to research it with Secure Horizons, because they probably were wrong, and that she would call me back.
Well, I wish I could put a recording on this blog, because I would let you listen to the voicemail she left me...Here is the gist (her voice professional, but suddenly much sweeter and pleasant)..."Hello Aimee, this is Debbie, I reviewed the transportation with the medical director and it has been approved, so I will talk to Magnolia to see how many sessions he has left and make sure they are scheduled. If you have anymore questions for me, please call me. Sorry for the error. Goodbye." I ran around my office and played the message for like 4 different people! Not only did I win, I got an apology too!
I immediately called her back, and thanked her profusely for being "soooooo helpful" and we are so appreciative that she took the time to straighten this out for us...I mean she should have, since I am pretty sure she jacked it up in the first place. But, because she did screw up, and tried to eat crow while it was still warm, I thought this was the perfect time to strike up a friendship..Well, a cordial relationship anyway...The more she knows about my Dad and the more she knows about the situation at large, hopefully we can get her to be on (or more on) our side. Then a funny thing happened...She said "And you know, I am concerned that you said he is not getting physical therapy, so I called and talked to Magnolia, and they said he wasn't getting it, and he should be getting something, so I am going to call and make sure that some sort of program gets set up as soon as possible..." I almost fell out of my chair...So, I thanked her profusely once again (it is kind of like training a dog...Positive reinforcement), and told her that if she ever had any questions or needed any information to please call me...And she said "the same goes for you..." I had to pinch myself...Now, I am not naive...I will believe it when I see it, but hopefully, Dad should get some form of activity soon.
The other pretty good thing that happened today, was when we went to radiation. I came down today for the first time to see a treatment. Wow...It was really something else. So, the "mask" I was referring to looks like a paper mache' bust of my Dad's face, neck and shoulders...Well, the front of my Dad anyway. But it is made out of mesh...Kind of like white fishnet stockings. It has plastic pegs along the bottom edge, that lock into grommets on the table. The table is in a huge room, with a huge, sort of round machine, that is kind of like a doughnut. The table that he lays on then slides into the doughnut, where they line up the radiation according to where the tumor was (and is).
While Dad was getting his treatment, Mom and I talked to Dr. Uhl, the radiation oncologist. Dr. Uhl was saying that if he had not been experiencing side effects by now, he probably wouldn't have any. What a blessing! He was also telling us that this type of tumor is very hard to get rid of, and even after treatment will tend to come back in an average of 10 months. Well, my Mom doesn't really understand what average is (other than "mediocre"), so he said that 50% of the people will have it come back in up to 10 months, and the other 50% will have it come back in 10 months or later. And he said that when it does, we can determine what treatment will work at that time. We just have to be dogged in follow up scans and if we notice any subtle symptoms, because it is best to catch it as early as possible.
So, although the prognosis for this type of tumor is not good (I have known that since the beginning), Dr. Uhl seems to be determined to keep fighting it. All in all, I think it was a good report.
I only saw Dad for a brief moment after his treatment. When he realized I was there he said "be careful...I may be emitting!" I said "what do you think? Are you expecting to glow?" He just laughed.
Oh, my last bit of information tonight is sort of a caveat to everyone. My Dad always paid for the Secure Horizons/AARP medical coverage because he thought it was better coverage. It covered medications and co-pays, and was pretty good to them, until all of this happened. I spoke to a close family friend yesterday, who works in the medical field, and he told me that in the industry, they call it "Insecure Horizons." When we were talking to Dr. Uhl today, he said the exact same thing, and he said that in the state of California, Medicare with the supplemental Part B is the best way to go. I am not telling everyone to run out and change anything, but be sure you know what you have, and what is covered and use our situation as one of the measures to evaluate what you have to make sure you have what is best for you. I get a different story every time I call Secure Horizons, but one of the operators told me that Medicare would cover custodial care...Which Secure Horizons does not.
I have plans to call Magnolia tomorrow to follow up on the activity for Dad, and if it has not been requested, I just may call my new "friend" Debbie...;)
Much love to all!
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