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Can things get much worse? :( - long post)

Can things get much worse? :( - long post)

Old Jan 12th 2006, 12:19 pm
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Unhappy Can things get much worse? :( - long post)

Ok, need to vent. I really, really need to vent. I apologize in advance for this post's longevity -- you don't have to read it, I just need to get this out of my system. Who knows, maybe my experience will help other people who are dealing or might deal with the same sort of thing some day.

But first, a brief recap -- believe it or not, I'm leaving out a lot of details because it would just take too long to go over how much of a nightmare I've been dealing with:

At the end of August, I had to leave work due to panic disorder and anxiety. My job as a call center supervisor is EXTREMELY stressful, and getting bitched at and cussed out for 10 hours a day just took its toll. It also didn't help that although Mark had been work authorized since Feb 2004 he still wasn't working. I felt trapped in my job, because it was our only source of income and provided our benefits. Living on one income for 2½ years also put us in a lot of debt. It just got to be more than I could handle; I was having 3-4 severe panic attacks every week at my lowest point.

Since September I've been seeing a psychiatrist who specializes in panic disorder; he even wrote a book about it. In December I started seeing a therapist as well because the medication scheme I'd been on just wasn't doing the trick.

I filed a short-term disability claim the day after my first appointment with the psychiatrist. It has been a complete nightmare from the very beginning, starting from when my claim was automatically denied because they didn't get any medical documentation supporting my claim within five business days of when I filed the claim. Of course, it would have helped, had they TOLD me about this five-day deadline when I filed my claim. That was the first of many errors and miscommunications initiated by my disability company.

I finally decided that the only way to ensure my disability claim would be approved would be to take it upon myself to get all the documentation and compile a comprehensive appeal. I wasn't really stable enough to do it all myself, so my mother helped me out immensely; she's had experience with insurance companies and other legal proceedings. She helped me figure out what documentation to obtain, how to write the appeal, etc. I'm a perfectionist anyway so of course I wanted to give them as complete a picture of my disability as possible, in addition to providing them with plenty of medical evidence supporting my disability claim. I started working on it in mid-October (when I learned of the denial), and finally finished the appeal and mailed it in last month. My mom and I sent about 30 emails back and forth to each other, plus multiple drafts of the appeal letter and discussions on what to include, not include, etc., working on it for about six weeks.

This past Monday I called to check the status of my appeal. To my dismay and surprise I was told there was no record of it at all. Funny thing was, I had sent it certified/return receipt and had proof that it was signed for on Dec 12th. But as far as the disability company is concerned, if they don't have a record of it, then it never happened -- even though I have proof of its receipt by a human being. Ironically, I mailed it certified/return receipt FOR THIS VERY REASON -- so that it was hand-delivered to the company and (so I thought) pretty much eliminate the risk that it would be lost. But they don't seem to care about that.

Keep in mind that I've already gone for OVER FOUR MONTHS with no income. (Mark finally got a job in October, but it's only a fraction of what I earn at my job.) And the last month of that was a complete waste of time, because I didn't know they had lost my appeal after it was delivered and signed by them.

I spoke with a supervisor who asked me to fax the documents to her. I told her I didn't want to fax anything, because that was an even greater risk that pages of the appeal would be lost and/or illegible. Then she asked if I could email it to her, an option which I readily accepted. She said that because my claim hadn't been denied due to medical reasons, but because the documents hadn't been received yet, her department should be able to review the documentation I sent them within a few days and let me know if they can reverse the denial decision. If they couldn't, they'd have to forward it to the Appeals Unit.

Finally, a ray of hope. My mother and I had worked so hard on the appeal that I felt confident that upon receiving the documentation, they would reverse the denial decision. Not only that, but my psychiatrist said that he's never had a patient whose disability claim was denied due to medical reasons. So, I was finally feeling pretty good about this.

I emailed the documents to the supervisor and my original case handler at 8am Wednesday morning. At 9.15am, the case handler (Susan) left a phone message saying that she was NOT reversing the denial and that she was forwarding it to the Appeals Unit.

WHAT!?!? I couldn't believe it, and still can't. It made no sense. So I called her, because after four months I felt like I deserved a real answer. It went something like this:

JENNEY: Hi, Susan. I'm returning your phone call about my appeal?
SUSAN: Oh, I was just telling you that I have decided not to reverse the denial and that I've forwarded it to the Appeals Unit.
JENNEY: Really? Can I ask why you won't reverse the denial?
SUSAN: Well, I reviewed the documents you sent, and the most recent document from Dr K [psychiatrist] was from way back in September. It's too dated now.
JENNEY: Forgive me, but that's not correct. He filled out the claim form in October, and provided me with an explanatory statement in late November. I included those in my email [which was a PDF document, btw] -- did those documents not come through properly?
SUSAN: Oh, yes they came through, and I reviewed them. But I have still decided not to reverse the denial and I've forwarded it to the Appeals Unit. [Can we say ROBOT??]
JENNEY: Well, I don't understand. If you received the documents and saw that they were completed more recently than September, I don't understand how that can be the basis for a denial.
SUSAN: I've based my decision on the information you provided. You'll have to take it up with the Appeals Unit now.
JENNEY: I'm sorry, but I've been dealing with this for over four months now and would really like to know what's going on. I've sent you a lot of information to review. So please explain to me specifically WHY you are not reversing the denial.
SUSAN: [Pause] Well... After reviewing what you sent, it was evident to me that in order to create the appeal that you did, you would have to be able to concentrate, have focus, use judgement and make decisions, just like you would in order to perform your job. So, based on what you submitted I don't believe you are actually disabled.
JENNEY: [Scraping my chin off the floor...]

Listen up, fellow perfectionists, and take note: My appeal was denied NOT because the medical information provided didn't support my claim. My appeal was denied because I was TOO THOROUGH. That's right, people! Someone who suffers from anxiety and panic attacks isn't disabled unless she's a complete basketcase, balled up in the fetal position and rocking back and forth in the bathtub for hours on end. Someone who puts together a coherent and comprehensive appeal over 6+ weeks with the constant help of her mother and other relatives couldn't POSSIBLY be disabled the way her doctor says she is -- even if he IS an expert on the subject!!!

I'm sure my psychiatrist will be thrilled to learn that I'm the first patient of his to have a disability claim denied. Moreover, I'm sure he'll be thrilled to hear that his expertise was completely ignored. Her tone when she told me also pissed me off to no end: She might as well started off by saying in a really sarcastic tone, "Well, if you REALLY want to know..." Bitch.

All kidding aside, I cannot verbalize was a massive blow this was to me. It was bad enough that my original appeal (the one they signed for) was lost and no one wanted to take responsibility for that. But to discover that all my hard work to ensure the APPROVABILITY of my appeal was actually used as the basis for DENYING it made me feel like I was not just taking a step backwards, but like I was being shoved backwards. For someone who has always strived for excellence and to cross all my T's and dot all my I's, it's something I'm having a hard time comprehending.

On the flip side, however, if I had just submitted the bare minimum, with no cover letter or personal explanation of my medical history, etc., they probably would have denied it because there wasn't enough documentation. I can't win.

I tried telling Susan that I didn't compile the appeal overnight or even over a few days, but that I had been working on it for months before I originally submitted it in December. I also tried telling her that I had LOTS of help from various people, that there was no way I COULD do it on my own; I wasn't in the frame of mind to deal with all of it by myself. Not only that, but there is a HUGE difference between being in my very stressful work environment and being at home. OF COURSE I'm going to have a bit more concentration at home -- that's because I'm away from work and the things that trigger my panic attacks.

But it didn't matter. She simply couldn't care less. She just kept repeating herself in that stupid, robotic, emotionless voice of hers.

I immediately called my mom and she said she would help me compile proof that she helped with the appeal all along. Copies of emails we sent back and forth, a notarized statement explaining how she helped me put it together, etc. Of course, now I worry that by presenting this additional evidence that it, too, will be held against me. It's a total catch-22.

So... rant over.

Well, believe it or not, aside from all this disability BS, there is one bright spot: I got a new job. It's where I worked before I worked for the credit card company, as a full-time framing designer. It doesn't pay as well, and the benefits suck (I don't get any vacation until I've been there a year, etc.), but it's a low-stress job, close to home, and something I enjoy doing for the most part. Some of my old coworkers are still there, so it'll be a nice, comfortable transition for me. I haven't technically resigned from the credit card company yet, but will do so this weekend. (My manager works on the weekend.) Once I made the decision to quit my current job, my panic attacks stopped; I haven't had one for about three weeks now. (Well, aside from the one I had after my phone call with Susan.) So, some good news. I start my new job on Monday.

Sorry for the looooooooong post. It's nice to have friends here, it's nice to be able to unload.

~ Jenney
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Old Jan 12th 2006, 12:40 pm
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Default Re: Can things get much worse? :( - long post)

Ok I read it all...now im traumatised and suffering anxiety. LOL only joking.

All I can say is good luck. Sounds to me like to you met with a power crazed jobs worth asshole who thinks she's some kind of demi-god. Either that or she just hasnt had sex in ages and wants to take her frustration out on you...

Either way run with the appeals. ...keep at it and you'll get there in the end.
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Old Jan 12th 2006, 1:07 pm
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Default Re: Can things get much worse? :( - long post)

Is this a little healthcare insurance provider or a biggie.

have you searched on line for similar complaints.

You were RIGHT. You were talking to a Robot. In fact, Insurance claims for Healthcare are exactly that. A life full of CODES and ROBOTS. So much so, the whole back-end process (computing) is being, or has been automated.

Doctors are LEAVING their profession in droves because they cannot themselves even get paid. Hence, they won't treat you WITHOUT approval. It's a vicious circle.

Still, what do we expect with such low cost American Healthcare (tounge in very big cheek).

I wish you luck. Stick to your guns. Find out who the CEO is and fedex them a small but polite letter. 99% of the time - this works. Especially if you CC your local congressman.
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Old Jan 12th 2006, 1:38 pm
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Default Re: Can things get much worse? :( - long post)

Sounds like the system is trying to grind you down. Don't let it get to you.

BTW, I hope your spouse, Mark, is giving you full emotional support during this experience. What you're going through effects you both so it's also in his interests to help you!
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Old Jan 12th 2006, 1:56 pm
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Default Re: Can things get much worse? :( - long post)

You need some bigger guns on your side!

http://www.scc.virginia.gov/division...ecomplaint.htm
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Old Jan 12th 2006, 2:35 pm
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Default Re: Can things get much worse? :( - long post)

Franc11s is spot on - contact the ceo/local congressman - that will often help to get things sorted in a flash.
Also show no mercy when it comes to complaining about your treatment to date - name names and take particular care to stress the incident with the registered letter.
As someone who works in insurance I can honestly say that these companies disgust me - the whole concept of a company making multi-million dollar profits through over-charging for premiums and welching on claims is abhorent to me.
As a good example of what your up against the US's biggest auto insurance carrier operates the following policy....if 2 cars are involved in an accident and both are insured by the company in question they will settle the claims on a knock for knock basis completely regardless of who is at fault. Both policies will now have a claim written against them and so both premiums will increase in the following year. Nice don't you think.
The main thing to remember is that these bullies don't like it up them, so stick to your guns and with a bit of luck you'll get there in the end.
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Old Jan 12th 2006, 2:43 pm
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Default Re: Can things get much worse? :( - long post)

Jenny, sorry to read about all your probs...any chance you could take this to the media, maybe your local TV station....seems you have it all compiled and so go for it, like you said in your post it's a warning for others...just a thought and good luck for Monday
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Old Jan 12th 2006, 3:00 pm
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Default Re: Can things get much worse? :( - long post)

Mrs Titchski and I went through a VERY similar situation to you when filing her ST Disability claim from her job. She developed Myalgia Parasthetica(sp.) and couldn't work due to excrutiating pain. The drone at the insurance company was a complete ****, who basically said he had all the power to deny the claim, his word was final, etc etc. He almost seemed to be gloating about it. Wanker.

What we eneded up doing was to contact Mrs Titchskis HR department who gave us the number of the local Rep. He was fantastic, apparently he was semi retired down here, but had been fairly high up in the company and pulled all sorts of strings for us to finally get the claim through. I just wish I could have seen (and beaten) the guys face when he was told to approve the claim.

Hope everything works out for you, it seems you'll be a damn sight healthier at the new (old) job than the call centre - I know I wish I was back doing what I was doing before coming to work where I am now, but hindsight is 20/20 and that job is 3000 odd miles away now
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Old Jan 12th 2006, 3:02 pm
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Default Re: Can things get much worse? :( - long post)

Hi, Jenney, I don't have any constructive advice, but just wanted to say how sorry I am that you have had to go through this.

Sara
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Old Jan 12th 2006, 3:09 pm
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Default Re: Can things get much worse? :( - long post)

hang on in there Jen

good luck
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Old Jan 12th 2006, 5:03 pm
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Default Re: Can things get much worse? :( - long post)

Stress and panic attack's are often miss understood by people who have never been in that kind of situation. You may be earning less money now but I sure you will be a lot happier, money isn't the everthing.
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Old Jan 12th 2006, 5:17 pm
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Default Re: Can things get much worse? :( - long post)

Jenney --

I have panic disorder with agoraphobia. I started out, 15 years ago, room-bound.

From that point I have managed to become, to the outside world, fully-functional. I have done what I listed once as my greatest three fears -- living alone, travelling far from home, and flying, especially a trans-Atlantic flight.

But as you know, feeling trapped and forced into a bad situation makes everything so much worse.

That is why I am dreading a flight to Amsterdam and wishing like hell we'd AOS'd.

Have you looked into "mental health parity" laws for your state? Is your plan self-insured, or not? If the former, you have only federal law on your side; if the latter, your state law will apply. Mental health parity means that serious mental health conditions must be treated the same as "physical" health problems.

Sounds as if the person on the other line was making a medical decision overruling your doctor. Her diagnosis that you are high-functioning enough to work is unethical.

I know that you know that you'll have to appeal and spend more time and stress on what is already a very stressful matter for you. But there are people out here who really do understand what you are going through.

Best,
Amy
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Old Jan 12th 2006, 6:02 pm
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Post Re: Can things get much worse? :( - long post)

All I can say, Snowbunny is how very sorry I feel for you. (By the way, I had no idea you were getting married - Congratulations! Is your groom a Dutchman or an English guy living in Holland?).

Your anecdote is yet another reason why the National Health Service in the UK is so wonderful despite all the gripes we may have about it.

All the best and I truly hope that your claim will be allowed ASAP.
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Old Jan 12th 2006, 7:11 pm
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Default Re: Can things get much worse? :( - long post)

Originally Posted by Englishmum
All I can say, Snowbunny is how very sorry I feel for you. (By the way, I had no idea you were getting married - Congratulations! Is your groom a Dutchman or an English guy living in Holland?).

Your anecdote is yet another reason why the National Health Service in the UK is so wonderful despite all the gripes we may have about it.

All the best and I truly hope that your claim will be allowed ASAP.
My groom is Toontje, a Dutchman, who is a member of this forum.

Jenney, I have a customer support job and I do know how very stressful it is. The only bright spot is that you don't need to keep a given job to file the I-864 AOS, right? I like my job, but it does scare me that I need to keep it long enough to file the I-864!
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Old Jan 12th 2006, 8:08 pm
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Default Re: Can things get much worse? :( - long post)

Wow. Not only am I extremely touched by everyone's kind words of encouragement, but I'm shocked that anyone actually sat down and read the WHOLE THING! Thanks for doing that, especially since I wasn't expecting ANYONE to actually read it -- it's so nice to know people care and that, unfortunately, some of you know from personal experience what I'm going through.

This is NOT a teeny-weeny company I'm dealing with here. It's a BIGGIE. I would say their name except that this is a public forum and I don't want to go there. I will say, however, that even though I'm obviously not employed by the aeronautics industry, I can certainly identify with the plaintiffs mentioned in this article VERY WELL, as they seem to have had the exact same trouble that I'm having now. If you see what I mean.

The funny thing -- well, maybe not FUNNY -- is that I actually had A LOT more I could have sent in with my appeal which I opted not to. The thing I deliberately left out was a "timeline of events" in which I outlined everything that happened, starting with when I first started having problems back in Dec 2004, all the way through November 2005.

This was the part of my appeal that took the most time to prepare. There were SO many mistakes made and misinformation given that I had a looooooooong list of who screwed up and when. It took a long time to prepare because 1) it started out as 11 rambling pages and that was WAY too long; and 2) even after whittling it down to only 4 pages, the timeline still had the potential of being viewed as a bitch session about how everyone screwed up except me. Even though that is the truth, I didn't want that to be used against me.

I included the timeline with the appeal I mailed to them back in December because I was told (incorrectly, of course) that the Appeals Unit would be handling it. Susan, my case handler, is not in the Appeals Unit, so I wasn't so worried about them reading about what I had to say about her. But when I learned that the email I was sending this week was NOT going to someone in the Appeals Unit but rather to Susan, and that SHE would be making the decision whether to reverse the original denial, I did not feel comfortable with her reading what I had to say about her mismanagement of my case.

And that's what burns me up the most. Assuming Susan actually has the balls to put in writing that she's based her decision on the fact that my appeal is "too thorough" for someone who is disabled, then any other documentation that I send in for my new appeal could possibly just be used as further evidence to back up HER decision, not to reverse it.

Phone rings... It's Maria from the Appeals Unit!

Weird -- I got a phone call from the Appeals Unit as I was writing this post.

Ok... So Maria is now handling my appeal, and she sounded very nice and like a human being with feelings and empathy. Here's the gist of our conversation:

She got the appeal this morning but hasn't reviewed everything yet. She asked if I had any additional information that I'd like to send in for consideration. I told her that was a very interesting question, and explained how I felt the reason Susan had given me for not reversing the denial was a catch-22: If I submit more paperwork, then that could actually be considered evidence that I'm not actually disabled, but if I do NOT submit more evidence, then they may not currently have enough to go by to approve my claim as it is. In a nutshell, I want to submit more info -- and HAVE more info to submit -- but I don't want it held against me.

I asked if Susan had noted in my file the denial reason she had told me on the phone. Maria said she hadn't -- BIG surprise. I asked her to put a note that I told her the denial reason Susan had given to me, that I want a permanent record of it in my file. I also told her that I wasn't surprised Susan hadn't put it in writing because it didn't make any sense as a denial reason.

I explained that Susan had clearly based her decision on a subjective review of the appeal's presentation, NOT the medical information provided, and I asked if this was a normal denial reason. Maria wouldn't give a definitive answer, but just said that in the appeals process they would be reviewing the medical information provided, and have a psychiatrist review it as well. She did say that what I'd written in my own words about my condition and how it affects me was relevant and helpful and would be considered as well.

After speaking with Maria, I feel that submitting more information -- as long as it's relevant -- will NOT be used against me. Or, at least I feel more confident that it won't be.

Unbeknownst to this company, I am actually seeing a psychotherapist now in addition to my psychiatrist, and HE was the one who finally convinced me to leave my job for something else. It is obvious when speaking to him that he does NOT like how my employer treats its employees, that he also has seen dozens and dozens of patients also employed where I work for job-related stress. I didn't start seeing him until last month, which is why he's not mentioned anywhere in my claim. He hasn't filled out a claim form, for instance. I think that once he learns that my appeal has been denied (he is aware that my initial claim was denied for administrative, not medical, reasons), he would be more than happy to help provide more medical evidence of my disability.

Maria said I could put a "freeze" on my appeal to give me more time to obtain any further info I want considered. I asked for a week, but can extend that if I need to. As before, even though I don't want to delay this process any more than I have to, I would feel better taking my time with it than feeling rushed and having my appeal denied. Because if THIS appeal is denied, I think that's it.

Ok.... Again this turned out to be a long post, unintentionally. I'll keep everyone posted about what happens. Keep your fingers crossed for me.

~ Jenney

ps. Just wanted to also say that Mark has been phenomenal in supporting me through this period. His period of (self-imposed) unemployment DID hurt my mental health and our marriage to a certain extent, but only short-term. Mark also suffers from panic attacks and anxiety which is the main reason he put off getting a job sooner. But he's sorted himself out now. He finally went to the doctor and was put on anti-depressives, which helped tremendously. He got a job as a bookseller and LOVES it. As soon as he got out there, working and meeting people, things really turned around for him. And even though taking this new job means a huge paycut for me, he's still supportive of it because he knows I can't keep going on this way. He knows he made a mistake, but he's made up for it now. We're cool.
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