BACKGROUND

As many of you know, Jodie was born with congenital heart defects and had surgery at 10 days and 18 months old. She did ok throughout childhood, but had to be on some medications through high school, then another was added in college. Jodie went on to grad school, and unexpectedly required a valve replacement in 2007. It turned out she was in the early stages of heart failure, but only found out after the procedure. She needed to get a pacemaker since her heart stopped beating on its own, and then a few months later upgraded to a pacemaker/ defibrillator due to low heart function. In 2008, Jodie was told that she would eventually need a heart transplant, and that the doctor predicted it to be necessary within the next 5 years.

In the 12+ years since then, Jodie was upgraded to a bi-ventricular pacemaker/defibrillator which helped her feel better but didn't improve her numbers, had it replaced two more times due to the battery almost running out (normal process), was put on a new medication that helped her feel much better but still didn't improve the numbers. Then in April of 2019 things started to get interesting. Jodie went into an atrial flutter and after 3 weeks, had to be cardioverted (think being shocked with paddles, but more controlled and while under anesthesia) to get her rhythm back to normal. Then over the summer she started feeling more and more tired, and having slightly worse symptoms. Jodie had some tests in August that showed things were worse, and the doctor told us in October that we would need to check back in early 2020 to see how things are. After having those tests, its clear that Jodie needs to have a heart transplant.


WHY DID WE START THIS BLOG?

Jodie and Peter decided to keep this blog for a few reasons. First, as a way to keep our friends and family up to date. Second, as a way to share how we are doing and what we are going through (and potentially what we need). Third, as a way to document this journey.

We have learned that we want the people around us, and those who care about us, to know what is going on, but don't always have the energy to talk about it over and over. We will be sharing was is "on our hearts" as we go through this journey. We welcome you to check in as often as you like. Thoughts and prayers are much appreciated. You are always welcome to reach out individually, but please feel free to leave comments on our posts and we will try to respond to everyone when we can. We are also planning to use this platform to share news when we don't have time or energy to send to everyone.

Some of our posts may be more emotional, and some may be about more mundane things. Once we get to step 4, it could take anywhere between 1 day and a year or more to reach step 5. We have no way to know. As we are in that waiting period, we do know that one of the things that will be helpful to us will be to keep busy - board game nights, movies, etc. If you are nearby, please do reach out. While Jodie can't be doing anything too strenuous right now, we still want to connect with people. If things come up that we need or could use help on, we may post it here, or reach out specifically to those who have let us know they want to help.

Thank you for walking with us through this journey as we share what is on our hearts. Please check back for updates. We will add information as it becomes available and as we go through the process ahead.

God bless,
Jodie & Peter Elliott

Wednesday, September 30, 2020

Insurance issues

I'm still feeling well today, but frustrated at insurance issues. If you're considering who to vote for this election, please note that only one of the people running is being clear about their healthcare plan.  Prior to the ACA (Affordable care act, also called obamacare), there was a clause that said that if you had a pre-existing condition that the insurance did not have to take you on a a client, or if they did, they did not have to cover anything related to your pre-existing condition.  I was literally uninsurable (I know, I tried to buy private insurance at the end of grad school when I aged out of my dad's insurance and COBRA ran out) unless I found a job with insurance without a pre-existing condition clause.  Please note that if the ACA is repealed and there is a pre-existing clause again, I would be uninsurable except via an employer, or claims related to my heart condition and transplant could be denied.  This would be catastrophic for us.  

I have received over $850K in bills this year. I put away $2K, my out of pocket max, pre tax. To my knowledge I had paid this already, so was confused by a bill from Duke for almost that amount again. I spoke to the finance person, who said it was all processed correctly, so I should call bcbs. I spoke to them, and they said I had met my co-insurance max, but that copays don't count towards it, so I do owe $600 for each hospitalization. They couldn't tell me when I hit my out of pocket max 

So I reached back out to Duke and they need me to find the Explanation of Benefits (EOB's) from my March hospitalization.  For which I have already found 4 seperate documents with claims from that period, and I know I am missing some.  So now I need to figure out how to get them, as the last thing I was doing while in the hospital and convalescing was paying super close attention to the mail.  I definitely owe $1200 I wasn't expecting, as it was not clear that copays aren't included. It's frustrating to have to be so on top of this, and that the two systems have different answers. This is why healthcare is my number one priority in the election. If things go back to his they were before the ACA, I could be on the hook for the entire $850K+. To give an example, my couple day hospital stay for food poisoning was $32K.  A clinic visit I believe is about $10K+.  Each time. 

Hopefully this only takes the few hours I've spent so far, and not much longer, to fix. I doubt that will be the case though, and now I have to spend time I would be doing other things in dealing with this.  This system is so broken. Please vote.  We have already successfully done so.  If you don't have a plan, please make one. I'm happy to help you look up any information you need.  Please vote as if lives depend on it (because they do)

1 comment:

  1. Just catching up on your posts. What a horrible clause they threw in there! I don’t know if anyone knew copays don’t count! I didn’t! Insurance companies play so many games while CEOs make millions..... the system is better but still needs vast improvements!

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