July, 2005
I guess summer has finally arrived in Santa Cruz, although I sometimes have trouble determining if the season has in fact changed. Living in Florida all those years it was always easy to determine, when after the 2.5 weeks of winter, that summer had arrived. It's really hard to call it spring when the mercury rockets above 80 and stays there. Santa Cruz weather is so much more enjoyable.
This year I thought my plans were all set as I arranged for my mother to arrive for a few weeks in early May and we would spend a few of those days in Phoenix visiting the grandkids, then enjoy some of Santa Cruz. Nothing like getting four generations together, and besides my neighbor had all but guaranteed me Phoenix weather in May was fantastic. Wouldn't you know I pick the one May that set heat records and the temperature hovered around 108 degrees. We all knew that it was important to drink lots of water, but I guess we didn't really understand HOW MUCH water you had to drink.
Since my mother is 82 and sometimes has a little trouble with mobility, I asked her at the airport if she needed a wheelchair, since it can be a considerable hike to the gate. Of course, she says no. Then after we have returned she begins to complain about feeling bad, stomachaches, purging liquids, can't keep anything down, very fatigued. She won't go see a doctor, insists on taking some over the counter medications and postpones her departure 4 days. Although she never really said so, I'm sure she was worried that if she went to the doctor or hospital her HMO wouldn't cover the charges and she would have incurred expenses that would have depleted her financial situation. This makes me wonder, how does one insure access to their medical coverage when they are on a trip? Is the treatment covered, or do you need to get permission first. What is the appeal process should they deny payment for treatment? Just how do you know you are getting the coverage provided by your insurance company? Are the charges being paid in a reasonable manner? If you live in California and are covered by an HMO or PPO, then you enjoy the assistance of an organization called the Office of the Patient Advocate (OPA) that can help you in dealing with your insurance company.
Created in 2000, the California Department of Managed Health Care regulates and licenses HMO's and the Office of the Patient Advocate helps protect the health care rights of people enrolled in them. The OPA produces a wide variety of literature that discusses HMO/PPO companies, their coverage and consumers rights. It can provide assistance with health care problems, provide referrals to community and other government organizations, and answer questions. So if you feel that your health insurance company is not providing you the care that they should in accordance with your policy, the first thing you should do is file a grievance in accordance with their grievance procedures. If you are still not happy then you may have need for OPA assistance. Call the HMO Help Center toll free at 1-888-HMO-2299 (TDD 1-877-688-9891) or use their website to get advice and assistance. Only by making our voices heard, can we insure our rights are protected.
My mom is ok. We think it may have been dehydration, which was serious enough. But we will never know for sure, since I never could convince her to see a doctor.
Remember - Disability is a random event that can occur in any life, at any moment.
- Michael Bradshaw, Central Coast Center for Independent Living