Hights Struggle with Insurance Coverage

During and following India (Chapman) Hight’s battle with sepsis, requiring her to have her hands and feet amputated, she and her husband came to many discoveries about preparedness for emergencies.

The two believed they were fairly well prepared, having some of the essentials, such as a small savings, health insurance and living wills.

When India was hospitalized for septic shock, placed in an induced coma and her hand and feet were amputated, the two learned they were not as prepared as they had believed.

Insurances

In addition to their health insurance, Kevin said they even held accidental death and dismemberment insurance, so when India was required to have her hands and feet amputated because of sepsis, he thought they would ok.

But it’s wasn’t an accident, Kevin said. It was an illness, so the accidental death and dismemberment insurance wouldn’t pay.

People need to make sure they understand exactly what their insurance is covering.

While Kevin had good health insurance through his company, and insurance was great about taking care of the bills while India was in the hospital, the two soon learned commercial insurance pays for home health care but does not pay for in-home care.

Home health care is where I have a nurse that comes in twice a week to make sure I’m doing OK and to change my bandage, and make sure my knee looks OK, India said.

Home care is where you need assistance just to do basic life, Kevin added. I really didn’t understand the difference at first, so there was some frustration there.

The question hung in the air: If we can’t hire someone to come in here, what are we supposed to do?India said. It’s been a real struggle.

Even though I’ve been on the medical billing side of it,  I never had to deal with this. You just always assume that you’ve got good insurance that will take care of it. Not necessarily.

If I had Medicare or Medicaid, then they would pay for it, India said. Because no commercial insurance companies pay, no home care agencies are set up to accept or bill insurance.

Reduced to one income and unable to afford the upwards of $22 an hour to hire a full-time home care worker, the couple relied on their mothers to assist India with personal needs and parenting every day.

The moms are constantly running, India said, of needing to be taken to her therapy and doctor’s appointments, in addition to grandmothers transporting her daughters to activities.

I feel bad for them, but I don’t know what we would do without them. Insurance won’t pay for someone to come in here and help me full time.

We were truly blessed to have had both moms just  step in 100 percent. Literally,  both of them were here 24-7 for over two months.

Basically, we have two spare rooms downstairs they moved in. We’re finally now at a rotation where it is one a week.

Those first two months, they literally stopped everything and were here, Kevin said. So it came down to we were very fortunate to have our moms.

Another problem in dealing with insurance companies is finding an expert in your area of medical need. For India, it is someone who has dealt with quadriplegic cases.

While the insurance company has been great about working with them, Kevin said, there is a lot of difficulty in trying to explain to different people he speaks with why India has need of specific equipment, such as a lift chair to raise her up even with the bed or couch, instead of a slider board used by paraplegics, who have arms, to help them transfer to their bed from a lower sitting chair.

I had to explain to them that she didn’t have hands to be able to use the slider board, Kevin said.

Power of attorney

Another thing the couple said people need to have in place is medical and financial power of attorney.

Kevin said he ran into two situations. The first was when he needed to acquire copies of India’s financial records.

Kevin believed because he was India’s husband, he could automatically have India’s records released to him.

He discovered differently. When he went to request them, the hospital informed him his wife would have to come down and sign to have the records released.

I told them that wouldn’t be happening since she was in a coma and had no hands, he said. It made no difference to them.

They are required to only release the medical records to the person to whom they belong, or a person who has legal power of attorney to represent the patient.

Kevin said he ran into a similar situation when he went to the bank to try to open an account in India’s name, so people could donate to help cover India’s medical related costs.

We just want everyone to be aware of the things we ran into Kevin said. We thought we were pretty well covered. We found out we weren’t.

Curated from Hights struggle with insurance coverage

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