‘You cannot be serious…….!’

The more senior of you, and I number myself amongst you, will remember John McEnroe’s (pre Federer, Nadal, Murray, Djokovic etc) disagreement with the referee on the centre court at Wimbledon.  My expostulation on second contact with my medical insurers was pretty much the same except I didn’t have a tennis racquet to threaten them with.  Not that they would have seen it.  I promised you a blog about the pitfalls of medical insurance and I apologise for the slight delay.  I have been fighting, with partial success, the onset of a serious bout of man-flu.

I am a member of my company’s medical insurance scheme which is a premium policy and allows for pre-existing medical conditions. Last year, I had a load of yucky looking fluid drained from my knee, followed by x-rays, an MRI scan, and an arthroscopy.  As explained in an earlier post, this was an attempt to delay the inevitable.  The insurers were terrific and very helpful.  However, a few months later I received a letter from the medical insurers stating that they would no longer support ongoing treatment of my knee which was deemed to be a chronic condition.  They would, however, consider further, appropriate surgery.  Five months later when my knee took a serious turn for the worse, I contacted the insurers and they authorised an appointment with my Consultant.  The day after the appointment I rang them and informed them that I needed a total knee replacement and that the surgeon required x-rays and an MRI scan.  After a pause in which I was passed off to someone slightly more senior, I was told that the appointment with the Consultant should  never have been authorised and that they would not pay for any x-rays or MRI.  Rolling this back, it would mean that I would have to persuade my surgeon, without any appointment, that a self-diagnosis of the requirement for a knee replacement was sound, book my own operating theatre, invite the surgeon and his team to turn up on the given day, and, just to make it really challenging, not give them any idea of what they were dealing with until my leg was opened up.  This, clearly, would lead to a great outcome. The confirmation of my supposition led to my John McEnroe moment.  I argued with them. A lot. It caused me a great deal of stress at a time when I was in a great deal of pain and just wanted my knee sorted.

I was given any number of reasons why they would not pay for the surgical pre-planning and, on one occasion, was actually told to get the x-rays and MRI done on the NHS!  This approach to the care pathway is novel in the extreme.  As it was a company scheme, I was supported by my HR team and they found themselves caught between an intransigent healthcare insurer and a grumpy, intransigent employee.  It was all to no avail, and I have ended up paying for all my surgical pre-planning.  Why, when I could have got this for nothing on the NHS, did I eventually cough up?  Basically, I wanted to get rid of the pain as soon as possible and I could afford to do so.  My surgeon had also recommended the use of patient specific instruments for the operation which is why the MRI was required. Essentially, engineers produce cutting blocks from the MRI scan which removes some of the need for surgeon judgement whrn cutting the bone.  Whilst the long term outcomes for this approach are unproven (they can’t be any worse, after all), the use of such blocks is less invasive and post-operative recovery much quicker, often resulting in a shorter stay in hospital.  What really annoys me is that, by paying for the MRI, I have saved the insurers at least 3 days of in-patient fees.

Check exactly what you are covered for before you get any treatment or start paying any medical insurance premiums.  I have heard, although I can’t confirm it, that one company will not cover treatment for osteoarthritis.  Last year osteoarthritis was an indication for over 90% of all hip replacement procedures. Bit of a blow when you have been paying medical insurance premiums for years.  Check the policy!

On Friday, I received a call from a lovely lady reminding me that I was due in for my pre-assessment on Monday.  I regard her as ‘lovely’ because she remarked that I was ‘quite young’.  No-one has said that to me for years so I was quite prepared to skip over the fact that she meant that I was young compared to the normal clientele in pre-assessment.  Whilst confirming my appointment, I asked whether I would need sticks or crutches after my operation and was told that the physiotherapist would determine that before I was discharged.  Whatever was needed would be made available to me. At an additional cost.  I have reverted to Plan B which is a raid on my parents’ under stairs cupboard.  They have had 2 osteotomies, 3 hip replacements, and 2 knee replacements between them (one is still angling for a shoulder replacement) so there should be plenty of aids to choose from.  It may hinder attendance at the flower club but, after all, my need is greater because I am still ‘quite young’.

Even if you have medical insurance, check to see what is covered in order to avoid any unpleasant surprises.

With only a week to go before my op, it would appear that I have been unkind to the Unfeeling One.  I have discovered that she is going into work early and halving her lunch break so that she has enough hours to come and pick me up when I am discharged. Maybe she is not so unfeeling as I thought………  Kneedyman

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