Saturday, 10 January 2009

Wheelchair Distributor & Private Insurance Frustrations!

Wheelchair Distributor & Private Insurance Frustrations!

August 29th, 2008: Okay, so after one full year of waiting, I finally have the proper basic manual wheelchair in a configuration that I belive will work for me. Just in time for the September Labour Day long weekend starting on September 4th. Within days of having the wheelchair finally in a usable form allowing me to "trial" it further in the real world, the invoice arrives in the mail. $6300.00 due on receipt.

Well, I would really like to try it out now that I have the proper chair with proper seat and proper back etc. - that's what the "trial" should be! I can't very well evaluate it when I've been given the wrong chair or have the wrong back etc.

The invoice dated early August was postmarked August 29th and received in the first days of September. Within days I get the phone call from the chair distributor asking if they can send a driver over to pick up the payment. No!! Perhaps others have a spare $6300 laying around but I don't, particularly after having spent any savings on medical necessities not covered by government agencies or private insurance.

Look, let me submit the invoice to my private insurance carrier to see what they cover. When I receive the cheque, I'll send it along to you as well as any balance owing.

Previously by phone, I was informed by my private insurer that "the chair would be covered up to 100% for the customary ammount allowed in our area". Huh? They may fund 100% of whatever they decide upon? $3000 was given as the upper limit.

First Submission Of Claim:
Early October - So I send in the invoice and wait,...and wait... After some three weeks I get notification that they decline to fund. They need to know what portion ADP (Assistive Devices Program) has funded. Silly me, as no place on the submission form did they ask for that information when I submitted it in the first place. As I was submitting the total cost it should be self evident that ADP was not assisting in financing. Delay tactic number one.

I write a letter indicating that ADP is not funding any portion of the cost. The entire cost is mine.

Second Submission Of Claim:
Early November - Off it goes until another three weeks later I get another notification that they once again decline to reimburse me for any portion of the wheelchair. Why? Because I have to PAY IN FULL and send them proof of such before they will consider reimbursing me. Couldn't they have told me this on the phone during my initial call or in the notice of the first refusal?? I may be cynical but I believe they are playing games with me hoping I'll get frustrated and drop my claim. Delay tactic number two.

During this time I've been getting repeated terse phone calls from the supplier's Accounts Payable department demanding payment. Bordering on threatening. Very uncomfortable calls! I try to calmly explain that I'm waiting to hear back from my insurance company. I waited a year for the chair, can they not wait a few weeks for payment???

Early December - Well, It's coming up to Christmas by this time and with savings depleted and creditors breathing down my neck for payment, it looks like it will be a very bleak Chrismas season. I still don't have anywhere near the full amount they demand.

I get a phone call from the sales rep who was in charge of putting the chair together. I tell him of my frustrations and suggest if they can't wait for me to work the financial situation out that they should come and take the chair back.


He proceeds to tell me that I've had the chair far to long and that the company will refuse to take it back!!
Well, I've had the chair too long because it took you a year to get it put together in a useable form for me!!
What really bugged me was that while the sales rep was speaking to me over the phone, he kept muching away on an apple or some food item. The sounds of him stopping to chew, pause, think express his dismay, pause and chew again grates on me even more long after the call ended.
At least give me the respect of offering your full attention.

I have to wonder at what point the wheelchair went from being a "trial" item to being my, yet to be paid for, possession? On which date did I cross the line?

So, in the end, I begged, borrowed, but being in a wheelchair, couldn't steal - managing to scrape together $6300.00 from friends and family. The bill was paid in full, the invoice stamped "Paid in Full" was submitted to the insurance company for the third time and after about another three weeks received a cheque for $3000.00.
I do feel bad that I may have depleted some of the monies which were slated to be paid to the insurance company's CEOs as bonuses on top of their million dollar salaries. Wouldn't want to yank bread out of their children's mouths....

The Sales Rep I had dealt with over the months never called back with a thank you but then again I guess that would be too much to expect.

Long after having received my "Paid In Full" stamped invoice from the accounting department, they called once again asking this time in a civil tone if I had had any luck with my insurance company and when they could expect payment. I had paid in full weeks ago.
What competence!

I guess that all health care supply firms feel anyone in my position has a HUGE insurance settlement and can afford to pay outrageous prices while the private health insurance carriers believe everyone with that same insurance settlement doesn't need private health insurance reimbursement. Not everyone has a settlement of any sort.

What exactly is insurance, of any kind, for?? You pay monies into a fund which you hope to never have to use but if you do you know that major expenses will be covered and reimbursed should some major unforeseen calamity happen. It is to cover those major unforeseen expenses which otherwise you would never be able to afford. If your house burns down, your insurance will pay to rebuild it and restore it's contents. We have insurance because the home owner alone would not be able to come up with this amount of money on the spot after such a major disaster. Would the insurance company insist on the home owner rebuilding the home out of his own pocket and then submit a claim and wait for approval and reimbursement?? No, the insurance adjuster makes an assessment of the damages and issues payment so that rebuilding can commence. How then is it that after a catastrophic illness and all it's unplanned out of pocket expenses, does an insurance company require me to pay in full for the item in question and then they'll reimburse some part of it? No wonder why insurance companies are loved about as much as lawyers and politicians.

The whole reason I had extended health care insurance was that if I ever needed a wheelchair, or other major health care item, that it would covered, in whole or major part, so that I could afford this necessity and it wouldn't further stress my financial situation. Dream on!

I don't expect sympathy for my situation but a little bit of understanding and even some compassion would be welcomed. I found none...