Medical Insurance

Wow, so much has happened since Friday, that I hardly know where to begin. Tom was discharged from the hospital Friday afternoon, which was somewhat of a shock to his father and me. The day before, we were told that he needed to be in a transitional type of nursing home, because he was not ready to be at home just yet. As it turns out, Tom was discharged because of medical insurance discrepancies.

Tom was officially terminated as of January 3rd - his employer finally had to let him go, after 3.5 years of long-term disability. His medical insurance coverage was still available to us, but at a very steep premium - $1,100 per month for the three of us, or $400 for Tom alone. We chose to keep Tom on his former employer's insurance plan because we were worried about the possibility of pre-existing medical conditions not being covered under a new insurance policy. So, Katie and myself will be covered by my employer's plan, and Tom will remain on his employer's plan.

Anyway, there is a temporary gap between the time that his insurance will be reactivated under the plan for terminated employees (called COBRA), and right now. That being the case, the hospital was not able to allow Tom to stay any longer. They needed proof of the insurance that was about to be re-established, but had not yet done so. Also, the nursing facility would not even consider taking a patient who did not have proof of insurance. The hospital did not admit all of this, but it is quite obvious that this is all true, after 1) trying unsuccessfully to convince them that Tom was not ready to come home, 2) being told that the insurance is not active, and 3) the fact that just 24 hours prior to his discharge, the doctors didn't think he was ready to go straight home. They sure changed their minds in a big hurry when the insurance stuff became part of the equation.

So Tom was discharged Friday night. A very large man (an employee) had to literally pick Tom up out of the wheelchair and place him into the front seat of my car. When we arrived home Tom's dad, Richard, and his step-mother, Eloise, and I had a huge struggle getting Tom out of the car and up two steps, and into the house. We tried getting him to hold onto a walker, but he couldn't support his own weight, so we brainstormed a little and decided to try using a swivel office chair. We lifted him onto it, and then the three of us lifted the chair with Tom on it up the two steps, wheeled him into the house, and helped him plop down on the couch. That was a very difficult endeavor for all four of us. His dad broke down when it was all over and had to leave the room.

The three of us know that Tom should NOT be at home. This is too much to handle. Tom has to wear diapers. He can't control his bowels. He can't roll over. His shingles are incredibily painful to say the least. He yells out in so much agony. He takes a very potent pain killer, but it does not help consistently because it is not a time-released medicine. He can't walk at all. He can hardly stand. He's not eating. He sleeps a lot. I can't get him to and from the shower. It is a huge job.

A friend of ours named Jim (a previous neighbor) came by to assist me in getting him up the stairs to bed (Tom slept on the couch Friday night). He lifted Tom off the couch and placed him in a wheelchair that Tom's dad brought to us. Then he pulled the wheelchair up the staircase while I supported the front. We wheeled him into the bedroom and Jim lifted him into bed, which was not an easy task for him. I changed Tom clothing and got him comfortable, put some medicinal cream on his scab, gave him his medicine, and went downstairs to thank Jim before he left. Jim looked at me and said, "Lisa, you can't do this. This is way too much for you to take on. You need help. Tom doesn't belong here." He suggested I get on the phone with Tom's insurance carrier and demand that Tom be placed into a temporary, transitional rehab facility, just like the hospital had planned on doing. He said that I should fax proof that he is covered by medical insurance, and explain that it will become active in two business days. The insurance will be retroactive back to Jan 1st.

This is one of the most trying times in our lives. I feel so badly for Tom. He is living a miserable existance. I'm watching him wither, and it breaks my heart and my spirit. I feel helpless...