[lexapro]

Some of you may remember a former member of these forums, bstone. I am his old roommate and he turned me onto Macs and this forum a while back. I have his permission to repost the following, which is a very scary personal account of his health and financial situation.

I can't respond to the political situation very well as I'm fairly apathetic (I know, I should change). But I can relay some specific answers if anyone has.

By Baruch Stone
September 2009

My name is Baruch Stone. I am 29 years old and I currently live in Cambridge, MA. I am also suffer from a chronic neurological condition and am officially classified as disabled by the United States Social Security Administration. I have a neurological condition that makes it very difficult for me to spent long periods of time sitting up or standing without suffering from extreme dizziness and extreme pain in my head. It is very debilitating. However, I was not always in this position.

In April 2007 I was sitting in the library at school studying for an exam when I suddenly felt very dizzy. I felt as if I was on a boat that was being tossed around in heavy waves. Thinking I was simply overtired I left and began to walk home. I called my doctor on the way and explain my symptoms. I was told to immediately go to the emergency room at the Cambridge Hospital, which I did. After several hours I was discharged with an “ear infection” and told to follow-up with an ear-nose and throat doctor.

It took until March 2008 before I was finally diagnosed and began treatment. In the interim I suffered, untreated, from extreme dizziness and extreme head pain. There is no cure for my condition. It is chronic.

Permit me for a minute to paint you a picture of my financial life, before and after.

In 2007 I was working for the Spherion Corporation as a full-time employee and going to school in the evening. I was a computer and systems engineer, with a contract to the Harvard University Art Museum. While there I was known for my high technical expertise, especially in the area of Macintosh computers. My boss at the museum, Esmond, liked me so much that he wanted to buy me out of my contract. We were in the last stages of salary negotiation when I got so sick to the point of being unable to work any longer. I was still a full-time employee of Spherion. At this time I was making over $50,000 a year and the negotiations were for quite a bit more.

Spherion provided me with an Aetna PPO and I had elected to pay into both Short Term and Long Term Disability policies. These premiums were faithfully deducted from my weekly paychecks and the money sent to Aetna and MetLife, the disability company.

When I still felt very sick in August 2007 I went to my Internist at the Harvard Vanguard Medical Associated. I was immediately referred for a brain MRI with contrast and to a neurologist. As the results of tests kept coming back with bad results my symptoms only got worse and worse. Then I had to stop working. I provided my disability forms to my internist, who filled them out.

I then went home to Chicago to live with my parents. This is around when the financial horror began.

I received a series of correspondences from MetLife, phone and letters, in which they indicated I had a “pre-existing condition” and thus my disability policy was void. After consulting with an attorney who specialized in disability law it turns out I went to my internist five days too early. I had not cleared the extremely long (and very unpublished) period of time between beginning to pay for the disability policies and actually being covered. Had I gone to my Internist five days later I would have cleared this time limit. As well, my condition began after I had begun working for this company and after I had started paying into the disability policies.

I simply assumed that since I was being given health insurance and that my premiums were paid on time and in full I would have nothing to worry about. The health insurance didn’t have a grace period, and it even covered pre-existing conditions. Of course this condition began AFTER I had begun paying into the disability policy. Somehow, using legalese and lawyers, MetLife still considered this pre-existing.

Due to losing the claim for disability I also lost my company health insurance. At that point I went from being someone with good health insurance and a monthly income to someone with no health insurance and no monthly income. If not for my parents I would have become completely homeless with no access to health care.

Just imagine for a minute the effect this would have on someone with a chronic, severe neurological condition.

My father, G-d bless him, had made a very wise choice back in 2004. He had purchased an individual PPO policy for me and had been faithfully paying my premiums since. I still had insurance- a PPO even. Thank G-d.

Upon the advice of my disability lawyer, I filed for Social Security Disability. After 15 months and a denial that required a written appeal and two visits to SSD’s doctors, I was finally approved. I began receiving a monthly income 1/5 of my previous income.

My PPO, Blue Cross Blue Shield of Illinois, is highly ranked by Consumer Reports. However the plan has somewhat large deductibles, co-insurances, co-pays and don’t forget the monthly premiums. $1000 deductible, $1000 co-insurance, $20 co-pays (per office visit).

For someone who only has SSD as their only source of income paying all of this is a lot of money. I have calculated it to be between 3-4 months of income. Add to this the cost of my rent, food and the other basics in life.

To add insult to injury BCBS has been denying pre-approval for some medications. I am required to pay the hospital’s pharmacy up front and then I get to file this bill with BCBS. They then get to decide if and when they will reimburse me, and at what cost. This is a medication which my neurologist feels I may need to have for some time. It is an IV medication that takes 6 hours to infuse into my blood stream. I don’t understand why my doctor, a board-certified neurologist and the Chief of Neurology at his large university-based hospital, is being told “no” by my insurance company. This medication is fully FDA approved and the literature exists to demonstrate it helps people with my condition.

When I called BCBS to ask about setting up billing for this medication ahead of time I was told that this is not possible. I will only ever be allowed to pay for it out of pocket and then bill it to BCBS, hoping they reimburse me. This costs BCBS more money than simply paying the hospital directly. It’s a waste of time and money.

For someone who is officially classified disabled by the government (it was a long and lengthy process) it seems to me that I should be exempt from all co-pays, deductibles, co-insurances and out-of-pocket costs. I simply do not have the income to afford all of this. I have a very cheap rent and I never buy anything. I live very frugally and I buy food only with coupons.

So, to all the people out there who feel that there is no need for healthcare reform and the government needs to stay out of healthcare issues, I simply ask- is the status quo acceptable? I was a productive member of society who had every imaginable insurance. I did my utmost to ensure I would be covered if the worst happened. The worst happened and I was completely screwed over by a huge corporation.

Legislation needs to be put into place that would eliminate the co-pays, co-insurances, deductibles and out-of-pocked expenses for the disabled. As well, the legislation need to make certain that we cannot be dropped by our insurance companies and that there is no maximum dollar cap for treatment. Ever. In addition, the legislation needs to make certain that any treatments, tests or other medically necessary things ordered by our physicians cannot be denied by the insurance company. Especially FDA approved drugs.

This is not mind blowing or earth shattering in any way. It is sane, it is reasonable and it is the right thing to do.

None of this needs to be accomplished by the government setting up its own public-option. I am not opposed to this, but I’ll let the politicians work out setting up a parallel system.

As well we need to automatically be granted food stamps, rental vouchers and reduced fare for public transportation.

This is my personal situation and my personal thoughts of health care.


I am Baruch Stone. I am wishing you good health. May you have a blessed 5770 and a happy new year. Shana tovah umetukah.

[stumblinmike]

Tragic story. I wish you the best. It's unfortunate that some insurance "person" could ruin your life. It's common knowledge that to be in the insurance game, you must sell your soul to Satan. Your story just proves it. On the bright side, the "person" who works for Metlife probably got a shiny new Lamborghini!

[lexapro]

FYI, bstone is back in the hospital....