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Medical Necessity

Posted Nov 13 2009 10:01pm

Medical Necessity

Sunday, June 8, 2008

I write much about my experience with my health insurance company. When I am not writing about my insurance company, I am still thinking about them. I try to think of them often because they are so thoughtful of me. I had to have this rather odd test recently. I have been having problems in the bathroom. My pipes are just not working quite the way God designed them. Anyhow, in order to qualify for a procedure to take care of this, I had to have another procedure to prove my complaint was real. (Okay, I am really trying to be vague here so stay with me.) My nurse and doctor are usually the first recipients of my health insurance rants. The doctor told me as far as he was concerned it was a go with the procedure. However, if I wanted insurance to pay for it, “We’re going to be needing some proof” he went on to add, “Don’t worry the insurance company will pay for the test to give them proof.” I could feel him holding his breath as I cried, “You are kidding me.” “They don’t think this is somehow, medically necessary?”

So apparently, these insurance people must think being catheterized not once, but twice, two “prove” I need further medical care is “necessary.” I am having bladder control problems and they want me to prove it? Do they just want me to wear Depends for the rest of my life? Well heck, just follow me around for a day and save us all some money. To say I was complaining and whining the whole time during the procedure would be correct. My nurse told me it was not a whole loss, I did have to take off work and have all sorts of things stuck in and out of everywhere but, I qualified! Then she added, and “This was the most fun I’ve had all week!” If she enjoyed it, I wonder how the insurance people are celebrating?

I think I will send them a box of Depends.

I write much about my experience with my health insurance company. When I am not writing about my insurance company, I am still thinking about them. I try to think of them often because they are so thoughtful of me. I had to have this rather odd test recently. I have been having problems in the bathroom. My pipes are just not working quite the way God designed them. Anyhow, in order to qualify for a procedure to take care of this, I had to have another procedure to prove my complaint was real. (Okay, I am really trying to be vague here so stay with me.) My nurse and doctor are usually the first recipients of my health insurance rants. The doctor told me as far as he was concerned it was a go with the procedure. However, if I wanted insurance to pay for it, “We’re going to be needing some proof” he went on to add, “Don’t worry the insurance company will pay for the test to give them proof.” I could feel him holding his breath as I cried, “You are kidding me.” “They don’t think this is somehow, medically necessary?”

So apparently, these insurance people must think being catheterized not once, but twice, two “prove” I need further medical care is “necessary.” I am having bladder control problems and they want me to prove it? Do they just want me to wear Depends for the rest of my life? Well heck, just follow me around for a day and save us all some money. To say I was complaining and whining the whole time during the procedure would be correct. My nurse told me it was not a whole loss, I did have to take off work and have all sorts of things stuck in and out of everywhere but, I qualified! Then she added, and “This was the most fun I’ve had all week!” If she enjoyed it, I wonder how the insurance people are celebrating?

I think I will send them a box of Depends.

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