Health Care Saga Part 13b—1 + 1=0

            Unlike most teachers this past summer who were not able to work summer school due to damaging budget cuts to our educational system, I worked. I can only thank my up-to-date Special Education credential for the opportunity. I have been involuntarily ousted from the Special Education classroom for the past three years at least for reasons that are shocking and bewildering to most everyone who hears my story. I was ecstatic to secure a position as a Special Education teacher not only for the income boost but also just to experience that “home again” feeling teaching my Special Education students brought. When this cockamamie health care whirlwind subsides, perhaps I will elaborate more on that. For now, I want to continue with my legal foray into resolving the issues that have been so pressing for the past four years.

            I took the opportunity to do more research into disability rights legal representation as things were winding down with the regular school year and in the educational pause between that and the start of the summer session. Thanks to the internet, I researched and found five or six firms or organizations who professed to be successful in fighting disability rights. There was one firm in particular which caught my attention. They had offices here and in a city just north of us and seemed to make good business fighting such causes. My only concern there was that they looked like they specialized in class actions. While I believe my situation to be a common phenomenon among people with disabilities, I had no idea what it took to organize a class action and dubious that we could get the necessary numbers together as I don’t really hear anybody talking about this kind of situation except me—though I know it happens. In any event, I had nothing to lose. Tired of phone calling, I emailed the contacts I had, gave them a synopsis of what I was looking for and waited. The firm I was hoping for and tried to follow up with, never responded to my inquiry.

            My husband will tell you I am loathe to writing anything down. I instead like to think I can rely on my memory which in the past I could. I have an uncanny memory for numbers, names and idiosyncratic moments of life. Most of it doesn’t mean much to most people and oftentimes I don’t deliberately try to commit these odds and ends to memory, I just remember them. I don’t like to admit this but I think my ability to “memorize” things is slowly becoming a thing of the past.  As I get busier and pulled in the different directions of work, family, marriage, friends and my various “causes”, I know I’m forgetting stuff—but I try to pretend I don’t. I find it both a blessing and a bane to remember stuff but  I’m proud of it because one of my favorite things to do as a kid in a doctor’s waiting room was to listen to my mother tell me a story from her childhood or family history and I wanted to be able to do that too. For this reason, this sense of “pride” I never wrote down who was the newest batch of lawyers I had contacted. Instead, I relied on my memory to remember who they were. And I thought I did a pretty good job.

I started my summer school session delighted to be back in my element. The position was only half time which was just enough to whet my appetite for these students without draining me entirely so that I could still enjoy my summer. One day, I had a pause in the hurly burly of class and noticed I had a message on my cell phone. It was from the Disability Rights Legal Center. To be honest I didn’t know how to react. I didn’t actually remember calling them. Added to that, didn’t remember what I called them about. In this time, I had vaguely thought about bringing another disability related lawsuit regarding a sub-par evaluation I received in a position I never asked for, sought and deliberately stayed away from in part knowing it would highlight my disability and not my strengths. As it turned out, I had some time to search my memory since when I called back; I ended up leaving a message and starting a familiar round of telephone tag.

When I finally got hold of someone, they explained who they were and after a brief exchange I decided I had called them about my teeth though I did let them know I had another issue I’d wanted them to consider when this was done. They let me know they were a legal referral service and advocacy agency run through the Loyola Law School and the intake line was commandeered by law students. They took down the details of my teeth saga. As always they marveled that it hadn’t resolved yet. The intake person said they would give their notes to one of the staff lawyers and get back to me on what they could do for me. I had heard such things before. I was frank with her about my skepticism by asking two things directly: did I have a case? How long should I wait to get a response from them? I qualified the abruptness of these questions reminding them that while they just joined this saga, I had been doing this for too long and had little patience to be strung along for very long with no hope from them. She soothingly said she understood and promised to get back to me in two weeks. I believed her.

Impressively, she called me back soon after—only to get my voicemail. We went on a short round of telephone tag. Thankfully, because I was only working part time, I had more opportunity to get on the phone—and I was relentless about it. I finally got to her and she said that while she still planned to present my case, she had gone straight to the cancer advocates at the DRLC and asked for their advice on the notion that insurance difficulties were all the same whether a person had cancer or a troublesome wisdom tooth. Apparently they suggested I talk to two state offices: the insurance commission and another office I didn’t catch the name of. I called up the insurance commission right away and told them my issues. As soon as they heard the words “HMO” they told me this wasn’t an issue they could help me with. I had to go to the Department of Managed Health Care. I told them I had already initially dealt with them and the out come was less than helpful. Didn’t matter—mine was a matter for the DMHC. A little annoyed, I called the second number. Turns out, it was the DMHC! I didn’t even bother to wait on hold to talk to someone, I hung up. I decided to wait for the DRLC to come up with something else.

As promised, a couple weeks later, the DRLC called without my reminding them. I tell you, I have begun to acquire a new appreciation for follow up. She inquired if I had followed up myself on either of the numbers she had given me and what they had said. I gave her the briefing that one office refused to assist me and the other was an office I had already dealt with to my dissatisfaction and was dubious they would be any better help if I asked them again. She accepted that saying they would enter into a Brief Service agreement with me. I had only to sign the agreement and then they would get on the phone and (to my mind) raise hell for me. I was so grateful and a little stunned really that things finally seemed to be going my way. We hung up and I waited for the paperwork to come in the mail.

The agreement wasn’t anything special. The only thing that caught my eye was that they were only representing me in order to get this issue resolved. They specifically stated they would not seek a monetary sum for damages or any other compensation. Like I’ve stated before, I am not a litigious person. While I believe I have a strong case to seek damages based on the longevity and ensuing events surrounding the basic issue, I try to keep my eye on the very basic end result that really has no monetary value: the sense of relief in getting the issue resolved. Reviewing the paperwork, my husband’s eye went to the permission I gave them in signing to use my case in promoting the work the DRLC does. He wondered if they would publicize my case any and what that opportunities that could bring to me.  That was only a fleeting wonderment as I signed and promptly sent back the paperwork.

I actually did not hear back from them again for a good while. I did try to call the only number I had to receive an update only to get their intake line answering service. They finally caught up with me (or I with them) and I spoke directly to the clerk assigned to my case. He was just checking in and wanted to have a few questions answered before outlining his plan. After a brief exchange in which he really only wanted to double check background details, he told me told me he had looked into applicable laws and was confident I had a legal precedent for this issue. He furthermore pointed out that both Kaiser and Western Dental were good, strong stand alone insurance companies. But, as he said, put them together and you have nothing because they don’t work together. He ended the conversation by saying he was writing up a letter to send to both entities. The letter from the DRLC on my behalf would essentially outline their position and request accommodation for this procedure to get done. I was relieved after we hung up because I thought surely Kaiser and Western Dental could not ignore this from a legal standpoint. The more I thought about my situation and the things he had said from his fresh perspective, I wryly concluded that this was one of those situations where math is not always absolute and 1+1 CAN =0. 

Health Care Saga Part 12b—Welcome to Medical Purgatory: the Sequel

            After a fitful night’s sleep in which I roused briefly in pain whenever I turned over, I arose  to a daylight that might as well have been shining a burning light on my painful jaw. Mechanically, I went to make myself a soft breakfast—no bagel and cream cheese for me this morning. As I sat down to slowly eat my scrambled eggs and sip my tea, the phone rang. It was the elusive employee of my doctor’s office who I had emailed the night before. I was so relieved to hear from him. I gave him a briefing of what had been happening the last few days and explained I wanted to come in to see Dr. Felsenfeld TODAY. I would wait as long as I had to in the waiting room. As I said that I mentally reminded myself that the longest I had waited for a doctor was six hours—a few hours of which was standing room only. I wondered to myself wryly if I would beat that record today.

            For a moment his concerns were more basic: When was the last time I had seen Dr. Felsenfeld? Did I have current dental x-rays? Had I cleared the visit with my dental insurance? I assured him that though I hadn’t seen the doctor in a good while, the office did have a file on me. I further told him that I had spoken to Western Dental and they had reassured me that they would fax over to them a blanket authorization to cover everything that needed to be done—including x-rays. He then checked the office fax machine and there it was—the authorization as promised. He then gave me this bit of news: Dr. Felsenfeld was out of town and wouldn’t be back for a week. Oh my god! I thought, does this ever end?! He offered to contact him by email and consult him as to how best to proceed. I told him that much as I wanted to see my own doctor, there was no way I was going to wait for him to come back. As I said that, I thought, there’s also no way I’m going to see a Western Dental doctor or the emergency room either. No, I said to myself, the only doctors I trusted at that point were my doctor’s colleagues at UCLA. I told him that and he agreed to look to see what could be arranged. The only appointment available was a 4:00pm appointment that day with one of the regular dentists at UCLA—likely the very last one that was only available because I insisted on being squeezed in. I took it without hesitation. I thanked him for his help and hung up. I then promptly called my mom and informed her of what was happening. I quickly packed a bag and corralled my cat into her carrier. With my cat in the backseat and our necessities in the trunk, I set off to my parent’s house finally feeling like I was moving forward on this issue and the period of inertia was over.

After arriving at my parents, I unloaded my belongings and freed my cat and flopped into bed. Now that I was home with my parents and had a plan, I didn’t feel like I had to be superhuman anymore. I could relax and let my mom and doctor take care of things—two figures in my life I had grown to trust over the years. I buried myself under the covers against a growing February cold front and dozed off—my cat purring beside me.

Later that afternoon, the appointment went without a hitch. I saw the doctor and of course he identified the infection as soon as he looked into my barely opened mouth. He was very nice if a little hurried in his treatment.  I understood that I had elbowed my way into the office so I chose to overlook the undertones of his demeanor. He set me up on IV antibiotics which he said would have been standard procedure had I gone to the emergency room. As he did that, he arranged for a prescription for oral antibiotics and Vicodin for the pain. I was never so happy to be prescribed pain medication as I was then.

Once that was in place, he proceeded to squeeze the IV bag so that it would drip faster—so I would go home sooner and he’d get off work faster. As he did this, he asked me for a run down of the “saga of the wisdom teeth”, which I gave him by rote. He then told me that Dr. Felsenfeld was actually in the office. He just wasn’t seeing patients officially until next week. His plan was this: I was to return the next morning for a “check up” with him. He would then call over Dr. Felsenfeld for a “consult” with “his” patient. From there they would write up the diagnosis and recommended remedy—extraction of wisdom teeth by general anesthesia t accommodate my facial issues and present that to my insurance as a preventative measure to keep anther infection from happening again. That sounded great to me so I agreed to return. As I left the office, I noticed my “new” doctor was leaving right on my heels as well. I filled my prescription of Vicodin at a local pharmacy and fell into a blissful, drug induced sleep that night.

The next day as arranged, I showed up for my appointment. He almost immediately called over Dr. Felsenfeld. Was I ever glad to see him! For the umpteenth time we went over the vicissitudes of my insurance situation. He postulated that we may have a stronger leg with which we could kick my insurance company into gear using this tooth infection.  I was all for whatever worked. He complimented me on my tenacity with this long enduring situation and he promised to submit paperwork to the office’s insurance handler so we could get things in gear. My “other” doctor then asked me how I was doing specifically with the infection and meds. Aside from still being in some pain the swelling was already going down and I was getting groggier every time I popped another Vicodin.

At home I called up my husband to apprise him of the situation. He informed me that he was already planning on coming home for the weekend.  I was glad to see him so I waited at home as I reveled in the lessening pain in my jaw. As I slid deeper into the torpor induced by the Vicodin I noticed with heavy surprise that it was snowing outside! I amused myself watching my cat blithely walking outside as snowflakes collected on her fur and whiskers. The only thing of consequence that I managed to do was call up my work and relayed a message for my time keeper that I was likely not coming to work on Monday. I could do little else.

My husband’s homecoming though brief, coupled with the comfort of being in my mom’s care lifted my spirits considerably and I was making what I thought was a speedy recovery. After my husband returned to work early Monday morning I opted to not return to work yet and spend another day with my Vicodin. Unfortunately, in my foggy state I must not have communicated that fact sufficiently to my work place. Later that morning they called me up wondering frantically where I was. It took a lot of effort but I apologized for the confusion but reiterated that there was no way I could come in that day. I told them I would call later to update them on my condition. I fell back into a sluggish sleep. As the day wore on, I resumed normal activities feeling stronger and less dependent on the medicine. I called up my doctor, braving the labyrinth of their telephone system to get updates on my case. I left several messages and played a recurring game of telephone tag throughout the day. Who did I forget to call in the flurry of phone calls? Work. Oblivious to that, my mom and I made plans where she would drive me to and from work in case sometime during the day, the pain returned and I had to take a Vicodin.

The next day, bright and early, much to my timekeeper’s surprise, I showed up for work. Apparently this time they didn’t expect me and had already made arrangements for a substitute. After a brief exchange in which I defended myself as not responsible for what I may or may not have communicated during the past few hazy days I told her I would leave but not before I set up my room for the substitute. As I hurriedly tried to gather up on the spot lesson plans, she called my room and did an about face telling me that she had cancelled the substitute and I was “allowed” to stay. I went though the day as best I could while being minimally prepared for students unsettled by my absence. At any chance I got during the day, I called my doctor hopeful that they could give me good news. I was playing what I felt was interminable game of telephone tag. It was only at the end of the day that I finally got to speak to someone with an answer. Despite the fact that the hospital tried to compromise and offer Kaiser a “discount” on the single day hospitalization--$6000 as opposed to $9000—they rejected the claim and we were right back at square one.

Fed up with trying to play by their rules, I started to think about taking another tactic—legal action.

Health Care Saga Part 13—1 + 1=0

I fully admit I am not a mathematician by any stretch of the imagination.  But the title of this installment is not an error. I know following this blog and my one woman crusade against the health care establishment has been a long and arduous journey. I appreciate those of you who have persevered in standing by me in virtual reality as well as in my personal life. If you stick with me a little bit longer, I will tell you how I came about this idea that 1+1=0 and what that means to me in this saga.

I am not a litigious person. I am actually very disdainful and even ashamed of people who are quick to call a lawyer or who file petty lawsuits at the blink of an eye. Once when traveling with my mom to see our relatives in Italy, we got stuck at an airport due to some mechanical fault with the aircraft carrier. Several times, the airline announced we would board but then, upon a second check realized that the problem still was not resolved. It became quite late as we waited for a resolution and admittedly many of us were feeling a little punchy from lack of sleep. I was willing to wait as I probably had an over developed sense of patience from years of sitting in the waiting rooms of medical offices. Things got interesting when a very vocal American who was to board the flight with us began demanding if there was a lawyer among us. It was almost like a bad political cartoon. My mom of course gravitated towards the Italians who were on the same flight. Being young, I stuck close by. The Italian reaction was very different. As they smoked their cigarettes, they discussed the overactive passenger and the futility and even folly of her demands.  Was this really the way to get on a plane? Did she really want to force the airlines hand? They could rush to try and mollify us by prematurely getting us on the plane with results I don’t want to think about. Eventually the airline summoned a new plane to replace the one we should have been on and we got Italy without further incident.

The point to this story is that I didn’t want to be that woman. I wanted to be sure I wasn’t overlooking an obvious solution to this problem that didn’t involve a lawyer. I hated to think that just as I gave up and found a lawyer, somehow things would fall into place and my dental issues would be resolved. Then I realized two things: this had been going on for four years and I had run out of other ideas. I was pretty sure I should not feel bad for wanting to seek legal representation. What also turned my decision was that I knew my husband agreed with this view. He was ready to get a lawyer long before my infection came about. He even told me so on many occasions but he respected that I had to come to the decision myself.

As a teacher I lead a busy and very insular life in many ways. I don’t meet a lot of people outside of work. By accident more than by design most of my friends are either teachers or social workers. I know very few lawyers personally. The ideal at this point would have been to bank on my personal friendship with one or another of the smattering of lawyers I knew and get legal representation (or at least advice) for free. I quickly deflated when I realized none of my lawyer friends had experience in this field of law and while concerned for me, they respected our friendship too much to give me less than the best legal advice to be had.

Nevertheless, I contacted a lawyer who was a friend from my days as an undergraduate. As with most college friendships as the years went on and we pursued our different lives, we had been seeing less and less of each other. In fact I actually hadn’t physically seen her since my wedding four years ago. Thanks to the internet though and other marvels of modern technology, we still kept each other apprised of important events in both our lives. She was keeping informed of this particular saga thanks to this blog. I knew we were still friends to the extent that I could ask for her help and advice. As predicted, she did feel I have a case but she knew her background in law wasn’t what was needed. What I was counting on from her was guidance on finding someone who could help me. As I knew she would, after doing a little networking through whatever channels she has at her disposal, she came through with some names. I finally had a starting point.

I contacted all of them. My husband, relieved that I finally agreed to handle the issue through legal channels did his own research as well. You would think that things would start to pick up from here. However, a few of the firms I called either did not return my phone calls, or the individual no longer worked at the firm. I did talk to a couple of office people. One after explaining my situation said plainly that they didn’t practice the kind of law I needed. I had more contact with a legal secretary of a firm that both my husband and my lawyer friend had coincidentally both found and was reputed to be very successful in dealing with HMO’s. I figured surely he would want to take the case. The legal secretary asked for a chronological recounting of all my dealings with my insurance company. I was never so glad to have this blog. Since I wanted to add a few names here and there and omit details/comments she didn’t need to know, I waited until I was on Spring Break which was a couple weeks away at this point to give my full attention to this task.

Once the time came, between this blog and the other details of time, place and names that I had omitted from the public to protect the guilty, I gave her a 3-4 page synopsis of my saga. Pretty neat trick right? I emailed it to her and waited. After a week or so, I called her to receive an update. She said the partners hadn’t gotten back to her about this but she would let me know as soon as she had some news. I have heard this song and dance many times before and make it a policy by now NOT to wait as I am told. But, I didn’t want to be a thorn in her side either so I waited another week. I called her again. Again, she told me they hadn’t gotten back to her. The next week, I decided to email her as well. Both in email form and over the phone, I was instructed to wait. After that, I limited myself to hitting the forward button on my original email on a weekly basis. After a few weeks of that with no results, I quit and contemplated my next move.

My decisiveness in this saga has been admittedly slow paced. I know that. I won’t completely hide behind the inevitable excuses of work, family and other life issues as I legitimately could. Whatever my reasons, I tabled the cause and chewed on my options until I had another “break” in my daily life events. Translated from teacher speak: I waited until the summertime. Early in the summer, I had relatives visit from the east coast. As we enjoyed the warm summer weather outside alongside my parent’s pool, the subject of my teeth came into the conversation. I told them how frustrated I was over the fact that no lawyers up to now wanted to take a case that for all intents and purposes was a legitimate one. Their opinion was what I was suspecting all along—legitimate the case may be but how much money could they really earn making a lot of sound and fury over a few small teeth? That sounded like a true enough reason to me. But what could I do with that knowledge? That’s what was stumping me. Now at this point, I could go on stereotypical tirade of how lawyers are just money hungry capitalists looking not at the cause but on what will give them the fattest paycheck—but I won’t do that. The reality in this economy is the majority of the lawyers I know personally have either lost their job at one time or another or are afraid of losing their job because there is not enough business profit being brought into the firm. Like any other profession, the “lawyer business” is trying to stay above water as well. My relatives did offer a suggestion. Perhaps I needed to look my case differently. Up to now I have been presenting it as an insurance violation. Maybe if I came at it from the perspective of a disability rights violation, I would have better luck.  I thought that was a fine idea. After they left, I began another round of research to find a lawyer practicing disability rights issues.

Health Care Saga Part 12--Welcome to Medical Purgatory

After some four years of circuitous insurance dealings over the fate of rotting wisdom teeth, the foreseeable happened—I got a blindingly painful tooth infection. I should have seen it coming. Over time many people had asked “Don’t your teeth hurt?” or some variation of that question to indicate that things could get a lot worse. I was used to living with medical conditions that were at best a little uncomfortable on a daily basis. I’m lucky because those other conditions, like my wisdom teeth could have been in a lot worse shape. In any case, I never gave that question more than passing consideration.


One weekend day, I found my face and neck to be unilaterally swollen and tender. From my perspective it wasn’t that bad aesthetically. My face had been swollen a lot more when I had reconstructive surgery several years earlier. But the pain as the day wore on went from mild to unbelievable. I survived the weekend keeping to myself and doing very little. But still, true to my stubborn, life must go on nature, Monday I went to work, lectured my students, ate my lunch (albeit slowly and carefully) and came home and had dinner. My husband was working on a job out of town at the time and wouldn’t be back for a month. I wasn’t planning on making a big deal out of the situation to him and over the weekend it wasn’t, but it had been a difficult couple of days. Going to work only made me feel worse.

He calls me every night when he’s away. I knew he’d worry about me if I told him I was in pain. I didn’t want to say anything because what could he do about it from where he was? I didn’t want him to think he should come home over some teeth—and I wouldn’t have let him anyway. But it had been a long day in more ways than just having to do with my teeth. When he called, after the normal exchanges in pleasantries I fell silent. My husband knows when I get quiet like that it’s not a good sign. He also knows pushing me to talk doesn’t do any good—I just keep more quiet. So he waited. On my end I was quiet because I was trying not to cry and thus alarm him. That lasted about a minute. I burst into tears finally being able to tell him how badly I felt emotionally and physically. We talked about my worry over what was causing the pain. I knew I had a tooth infection but never having had one in the past I wasn’t sure how to proceed. Other times I had been sick, I could wait a few days for an appointment.

The only time I had pushed for an appointment was when my shunt had broken years before and I saw my neurologist. It may sound strange to most people but I wondered if “regular” doctors (like a dentist) took emergency appointments. You may be wondering why I didn’t go to the emergency room. Having had that experience before when my shunt broke—I wouldn’t go. To quote Helen Hunt in “As Good As It Gets” I got “whatever nine year old they just made a doctor” The last time I went to the emergency room they totally misdiagnosed me and overlooked obvious shunt malfunction and sent me home. That resulted in my loosing my eyesight temporarily. It was only after losing my eyesight that I pushed to see my neurologist. So, in a nutshell I didn’t go to the emergency room because they didn’t know what to do with someone with my medical concerns.

Back to the matter at hand, my husband wanted me to at least take a few days off work to rest and do the necessary squabbling in order to have this taken care of in a way that was comfortable for me. Through the excruciating pain I had one thought—my students. I didn’t want to leave my students to just any substitute—I knew they would tear him and my room apart. My husband tried to persuade me to look the other way—my condition was more important. But I wouldn’t do it until I was sure the right substitute could be gotten. My husband knew I wouldn’t change my mind. He didn’t agree but he dropped it.

The next day, I went to work in really bad pain from the start. Believe me; being with my students did not help. Between the usual teacher directions and corrections, my mouth was so painful and sore by the end of the day I actually felt stiff. Still, as soon as the last bell rang, instead of heading towards my lesson plans, I picked up my cell phone. I called up Western Dental member services and gave them a blunt rundown of the turn of events. I called up Kaiser too and gave them grief because had this been settled long ago as it should have, this would not have happened. They were concerned but inactive. I went back to Western Dental and demanded to see my specialist, I wouldn’t see anyone else. They quickly agreed to send an authorization to his office.

I am forever cognizant of how busy my doctor is. Also, I was skeptical that the authorization Western Dental faxed over delineated the urgency of the visit. My understanding was that it was a blanket authorization to see the doctor and have whatever needed done, done. Not trusting Western Dental anymore, I made sure they spelled that out for me. I didn't think I could see my doctor that same day. The distance alone prevented me from getting to his office before the close of business. But I was determined to see him the next day. So I luckily was able to make arrangements for a substitute I knew to be good. Anticipating the time it would take for me to heal; I wrote admittedly sketchy lesson plans for two days. I went home to think about my next step.

It was agonizing for me to think about my doctor's insurmountable telephone system in my state. But I had to see him without delay so I had to communicate with someone. I remembered early on in this saga I had communicated with someone in his office by email. Whether he was an office assistant, physician's assistant or what have you, I still to this day do not know. But I knew I had his email. So I wrote to him directly explaining the current state of events and implored him to let me see my specialist the next day without delay. At that point, it was all I could do. In a way, it made me feel stronger just doing that. When my husband called, I told him what I had done and what I intended to do. He was relieved that I had given up on going to work and of course asked to be updated on whatever happened next.

I then called my parents. Like with my husband I hadn’t wanted them to worry over me and my medical issues. In a strange way I would have felt guilty that my medical issues caused them this worry. In the last few days I hadn’t told them anything though being nearby they would have readily helped in any way they could have. I called them because I wasn’t sure of the outcome of the doctor visit—whenever that happened. The last time I had an emergency visit I went straight to the hospital. With my husband out of town I knew if that happened I needed someone to drive me at least. More importantly I needed someone to be with me should I go straight to the hospital—for no other reason than moral support. I am a staunch believer in that no one should be left alone in the hospital ever—not for a tonsillectomy or a heart transplant. Growing up I had the “luxury” of having my mom stay with me in the hospital almost round the clock with regular visits from my large family. I firmly believe that had a lot to do with my speedy and successful recoveries. Some people would say I was just lucky my family was in a position to do that—and I was. I still believe that in practice, keeping any hospital patient company should be so common it should be expected—almost taken for granted.

But I digress again. I updated my mom on what was going on. I told them that I would have more details hopefully the next day if the office returned my email. I wanted to drive out to my parents so my mom could drive me to the doctor—they lived much closer to him than I. I also anticipated that I would need a few days recovery whatever the doctors did so I told them I would bring my things to visit for a few days—including my cat. Of course they agreed.

I hate the feeling of being “neither here nor there”—of being stagnant if you will. Having been brought up as a Catholic this is what I would term “Purgatory”. That’s what this situation has been feeling like—a medical version of Purgatory. But, in a weird way, this tooth infection made me feel mobile. Something was going to be done about my teeth. I knew it was just to resolve the issue of the infection but I was hopeful it would mobilize the powers that be to act on the root cause (pun intended) of the situation—wisdom teeth that needed to come out. I went to bed that night feeling better than I had in the past few days--despite the throbbing pain in my jaw.

Health Care Saga Part 11--Oh to be DONE with this Mess!

I held off so long on posting this. I really, REALLY wanted to post a final, triumphant end note to the bureaucratic mess the “United” States of America calls a health care system--this is such a divisive issue for the country to my mind. But I have to face facts. It’s not over. Once hopeful I could see the end zone, I’m now skeptical it will be settled by Christmas. That would be a Christmas miracle. My frustrations and ennui aside, let me catch you up.


After the holidays, I called on Western Dental Corporate and had them resurrect my old authorization. My sister was right, since it had never been acted on, it was still valid. That worry aside, I concentrated on Kaiser and setting up the surgery with Dr. Felsenfeld. That’s when another unwelcome road block appeared. I had always known my doctor to be a very busy man. I looked at it as a testament to his expertise. That’s one thing that made me want to work with him—the fact that he could be so busy and successful and yet still is a pleasant person. His office informed Kaiser this: his busy schedule prevented him from traveling to other hospitals to perform surgery. Besides, there was also the fact that his liability insurance did not cover him on procedures performed at other hospitals. So, Kaiser came up with Plan B, which I must say was a fine solution me.

Kaiser proposed this: they would arrange for the surgery to be done at Kaiser by a doctor who was contracted by both UCLA and Kaiser. Now, I’m new to Kaiser and I really don’t know much about the repute of their individual doctors. Despite liking the efficiency of their record keeping and that all my records were essentially available to all my doctors under the Kaiser umbrella—saving me the dreaded “broken record” repetition I was accustomed to as part of having a multi-faceted disability, I was still skeptical. In the back of my mind I still viewed HMO’s as “assembly line, one-size-fits-all” medicine. Therefore, I figured their doctors would of the same mindset—at least for the purposes of keeping their job. However, the one saving grace with this proposal was the doctor that was suggested was also a doctor at UCLA. I knew UCLA to be a very reputable institution and figured they would be less likely to hold on to lemon doctors. I decided if I needed added reassurance, I could always ask Dr. Felsenfeld for his recommendation of this doctor.

My husband once observed about this whole journey that for “every step forward, take two steps back”. That’s a very astute observation. I would agree that it was a good characterization of events. I was confident it was a thing of the past. From now on, it would be smooth sailing. I gave the Kaiser representative the go ahead to make arrangements. She said she would get to it right away. Not long after, she called me back with news. What she said specifically escapes me by now. But she might as well have said, “Take two steps back.” In the time I had been dealing with Kaiser, it never really occurred to me to check that everything was still agreeable with Western Dental. After all, they issued an authorization for their part of the procedure. What’s more, I had been getting regular cleanings during this time. I know the people in my branch office were aware of what was going on because whenever I went in there they inquired about the status of my situation and marveled that it hadn’t been resolved. What they didn’t tell me, and the Kaiser representative told me now over the phone, was that in this time, Western Dental had added to their services. They now covered anesthesia. In addition, when the authorization had first been issued, it was assumed that the procedure would be done by Dr. Felsenfeld, at UCLA. They did not work with Kaiser, nor would they honor any part of the authorization if it was fulfilled under a Kaiser roof.

In a fit of frustration—I think I was crying in anger by now—I decided I had to hear it for myself. To be so close and then have the rug pulled out from under me again was infuriating. I called up Western Dental member services and demanded an explanation from someone. At first I got brushed off and was simply told to go ahead with my plans as they were, bill Western Dental after the fact, and they would reimburse the hospital. I desperately wanted this to be true so I could put an end to this. I went back to the Kaiser representative intending to tell her this. Working for an HMO she knew how these things worked. She urged me to call them back and double check. I did so the next day. I spoke to someone else who said essentially that that was not true. When I asked why I was told differently the day before, she could not answer me. In any case, I tried to clarify; Western Dental would pay for the whole thing—including hospitalization. She told me to submit my request and Western Dental would take care of it. When I pressed the issue of hospitalization—by this time I was looking at my Evidence of Coverage papers as I talked to her and not seeing any indication that they would cover it—she said they would take care of things. She said they had already authorized the tooth extraction at UCLA so adding on more would not be a complicated issue, as long as it was done at UCLA. I did not know what to believe but decided to give the go ahead to submit the authorization request and see what came about. I told the Kaiser representative that I thought it was resolved and despite the circuitous nature of the events, it looked like I would get what I originally planned.

Before I could hear back from Western Dental, another stumbling block not related to insurance issues occurred. I got a monstrously painful tooth infection. In my next installment I will talk about how I handled this completely preventable turn of events—and how infuriated I’ve become with the health insurance establishment.

Health care Saga Part 10 The End is Near! Can You See it?

I haven’t been this happy to be told I was having surgery since I was 24 years old—that was over ten years ago. At the time I was very ill as a result of one of my many other medical conditions. Had I known about blogging back then, I could have gone on about the dangers of someone with my medical history dealing with surprisingly uneducated doctors who also refuse to acknowledge their ignorance. But I digress.


Getting back to the subject, early last week I was checking my messages on a break from work. My cell phone registered two or three messages from a name I didn’t recognize at the DMHC. He said he had some information regarding my case. I called back only to get his voice mail on his lunch break. I was very curious and did not want to play telephone tag with this person. I left a message asking him to call me back at a very specific time when I knew I could take his call.

Surprisingly, I had some time before the specified hour. I could have waited for him to call me back but I was too curious. I called and this time he answered. At first he was a taken aback because he quickly tried to clarify that I had left a message saying to call back at a specified hour. Then, he tried to assure me that he would have. I was very calm about his fluster and simply said “I unexpectedly had the time, so why wait?” Satisfied with his customer service duty, he proceeded to tell me that after all evidence was looked at, the final decision was to overturn Kaiser’s initial decision and require them to pay for the hospital stay and anesthesia. I would receive the details of the decision within the next few days. I was also to receive a phone call within the next 5 business days from the Kaiser Corporation to talk about scheduling and details, etc. He also emphasized that if I did not receive the phone call within those 5 days, the paperwork I would receive had a name and contact number I could call immediately at the DMHC to report the breach of protocol. I was relieved to hear that as at this point, I didn’t trust Kaiser to cooperate with much. I had so many questions, but at the top of the list, I had to ask: “Will I be able to have the surgery done by my chosen doctor?” He couldn’t tell me the answer to that. He explained that the DHMC looks at services to be provided. It was not their business to determine who would provide that service—that was between me and Kaiser. That made me a little nervous but I had to be satisfied with what I had achieved. I finally bit my tongue and thanked him profusely for the news.

I was so excited, I immediately made two more phone calls to the two people I knew would appreciate it the most—my husband and my parents. My husband was taken aback by the news. He hadn’t expected it to come so it took a bit to have the meaning of my news sink in. But in the end he was happy for me. I called my parents and spoke to my dad. Now my dad has his own medical issues due to age that take up most of his energy. He has been intermittently vociferous in his support of me and my insurance saga. Understandably this has coincided with how he has been feeling on a day to day basis with his own health. Anyway, I told him the news and he was promptly congratulated me and expressed his relief. I asked him to have mom call me later so I could talk about the details. That evening, I spoke with my mom and essentially she had all the same questions I did. When would it happen? Where would the surgery take place? Who would perform the surgery? Obviously, she was still skeptical that it would happen since I didn’t have all the details—so was I really. I explained to her that I didn’t know but the DMHC said they took care of everything and once the paperwork came, I would have the name of a contact person who would take care of things if Kaiser dragged their feet.

Within the next couple of days as promised, I received the details of the decision. The medical reviewer (who was nameless but I wonder if he/she was one of the many specialists I had seen over the years—that would be a funny coincidence.) essentially agreed that it was medically necessary for me to have this surgery in a hospital setting with anesthesia despite the fact that it was a dental surgery which technically is not covered by Kaiser. I could tell they had thoroughly gone over all the paperwork I sent them because they actually quoted me from the personal medical litany I included—not just the professional medical records. That pleased me to see that what I had to say was given its due attention. I breathed easier when I saw the name and number of the DMHC contact should Kaiser continue to stall. I noted when the letter was dated and reminded myself to call the DMHC should the fifth business day come and go with no word from Kaiser.

Late in the afternoon on the fifth business day—essentially as late it could possibly be without Kaiser violating the arrangement—a woman from Kaiser Member Services called. She told me that Dr. Felsenfeld would be allowed to perform the surgery at a Kaiser facility. They needed to contact him to start the process of granting him hospital privileges. She also said the duration of the authorization would be determined by Dr. Felsenfeld’s availability. That seemed perfectly reasonable to me as I knew my doctor to be very busy. So I gave her his number and she said she would call him to get the ball rolling. If I had any questions, I could contact her. It would be that easy. I fought the urge to tell her I couldn’t believe that such a simple thing was made monumental by Kaiser’s bureaucracy. After all, she was just a cog in the machine. I did tell her I was glad this mess was finally over and I would be sure to call her with any questions or other problems. She got my meaning. I hung up with only a mild worry about how she would deal with the messy answering system at Dr. Felsenfeld’s office. I figured once she identified herself as being from Kaiser, and her business related to my dispute, maybe they would give her call a priority. In any case it was out of my hands and I could only be patient—for a reasonable amount of time.

Still something continued to bother me. The word authorization kept ringing in my ear. I realized that though Western Dental had authorized their part of the bargain long ago, that authorization had long since expired. They had told me at the time that it would be a matter of nothing to extend the authorization. I was afraid that was just an easy way to get me off the phone. So I called my dentist’s office up and explained the situation, asking to speak to the person in charge of authorizations. They said she wasn’t available. Determined to get this done, I put on my raincoat and went out in a pretty bad rainstorm to go to their office. The waiting room was packed. I explained my situation to the front desk and she relayed the information to the person in charge. She sent back a cursory response that they couldn’t reauthorize it. Not to be out done this far into the game, I asked to speak to her directly to more fully explain the details. I was told when she was finished with another client, she would speak to me. I waited, standing for most of the time with one of the office staff telling me at intervals that she was still busy. I waited as long as I could but I had to leave when I couldn’t wait any longer. I told them I would be back.

My family was in town at the time. I spoke to my sister who is a nurse about the situation. She pointed out that since the authorization was given once, they should not have any problem giving it again since it was never actually carried out. She also made a point that maybe I should wait to see what the authorization timeline would be for Dr. Felsenfeld so I could more concretely negotiate with Western Dental about the timeline for their authorization. What she said made sense. So I decided to wait and hold off on going back to my dentist. With the holidays mixing things up, that wait turned into longer than I would have wanted. But in the interim, I realized, to expedite the process, maybe I should talk to the western Dental Corporation directly about extending the authorization they initially gave—cutting out the middle man and hopefully cutting time and aggravation. Now that the holidays are over, I hope I will get the answers I want and everything will finally be in place.

Health Care Saga Part 9--I think I'm Spinning My Wheels

I told my sister-in-law once that this health care saga will probably be a ten parter before it is done. I said that sardonically but it looks like it is truth. All this hassle for a few little teeth most people don’t think two thoughts about. In any case it looks like it is out of my hands now. A few weeks after I finally straightened out the paperwork to get my records to the DMHC I contacted them to make sure they did indeed receive my records. My lawyer, (boy do I like the sound of that) reassured me that they had and everything was ok. The procedure is that the independent medical reviewer had a month to make his determination and get back to her. By the time I had emailed, that meant another week or so. Satisfied that my case was not forgotten, I went about my daily business and got ready for the new school year. After the school year settled my mind wandered back to my teeth—as always. I emailed my lawyer for an update and strangely, she didn’t get back to me immediately as she had before. I immediately thought—“Oh crap, they finally forgot about me or hit a dead end.”


Actually, they hadn’t forgotten me. About a week after I emailed my lawyer, a letter came through snail mail. The return address was the DMHC. The letter was not signed by my lawyer but a legal secretary working with my lawyer. Essentially the letter said that my case is turning out to be more complicated than anticipated and would need further investigation. Obviously it had exceeded the 30 day time line and they didn’t indicate how much longer it would be. It completely baffles me that a case of simple tooth extraction—even with my medical complications—could be so complicated. My only conclusion is that again, it’s not about my teeth. It is about an HMO unwilling to do its job and look after the health of its clients. My husband thinks Kaiser is throwing paperwork at the DMHC. I would tend to agree with him. It turns my stomach to think of all the money Kaiser is wasting trying to quash my request. That money has probably exceeded by now the money it would take to actually grant my request. I ask you, is this the way you want your money spent by your HMO?

I would love to keep up this blog, but this particular issue is just going nowhere and is literally out of my hands. I am satisfied that the DMHC is doing everything they can and will go the distance with this. But without knowing the details of what is going on with my case, I really have nothing to report until the DMHC either wins the case or gives up. So, I want to go back to my original intent of this blog. I intended this blog to be a record of issues I or my students encounter on a daily basis as people with disabilities. I promise that as son as I know anything else regarding my teeth, I will post that. Until then, I would like to discuss an issue in my next post that I have considered from time to time over the years and most recently in the past week it came to my attention again—eugenics. Look for a new post with my thoughts on the issue soon.