Okay, just wanted to update you on what we are dealing with.

I called all the Wound Treatment Centers covered under Alan's medicare HMO. Seems that Wound Treatment Centers bill as a clinic visit and it's a $50 co-payment each and every time you go. So if you go 3 times a week, that's $150 a week and since we live on $900 a month after the rent, who on earth has $150 a week to spend on wound treatment centers. I can't imagine what a person does if they don't even have insurance, and he has Blue Cross Blue Shield.

So we did the next best thing. Since he has already been to Methodist Hospital for the stent, the neurologist, and other things, and they have all his medical history, they have a podiatry department.

I phoned them and just spoke to the person who handles everything. I told them about his recurring foot ulcer and I just wanted to make sure that if Alan went there, that they just don't do debridement (which he has had done for 18 months). I explained that his regular podistrist recommended bone shaving but they won't do it.

I simply asked "if the podiatrist, after examining my husband, says "oh, he needs the bone shaved", will the podiatrist recommend to a surgeon in the hospital to do it?? And she said "oh the podiatrist here does that". I said 'oh really??" so if my husband needs this, it can be done on an outpatient basis?? and she said "oh we do this all the time". Now I don't know where they do this, if they do it in the office, or in the Methodist Hospital itself (I didn't want to start asking so many questions, that I would come off as a person who yaps their heads off). I had asked blue cross if any procedure is covered and I was told that Alan is covered either for any in-patient surgery or any outpatient surgery..

I then was told that he only has to pay the specialist co-pay (believe me, it's not $50.00) So we decided to go this route.

His regular podiatrist absolutely told us to go to a wound treatment center because even though he recommended shaving down the bone, the actual doctor who runs the practice said "no, we can't do that". I have no idea why. I didn't ask any questions.

So this tuesday, on the 7th of August, Alan and I will go to Methodist Hospital to the podiatry department, and hopefully, after 18months of recurring foot ulcers, me doing wound dressings, every morning, and oft-loading shoes.....maybe, just maybe.... this new guy will say "oh, I know what he needs, he needs the bone shaved" Alan will be bringing all of his medical records and x-rays from his present podiatrist.

Now my question is this. How do we address this new guy?? Do we say "Alan has had recurring foot ulcer for 18 months, we've done the wound dressing thing, we've done the oft-loading shoe thing", "nothing has worked", do you think you can shave down the bone?" Is this okay to say??

See, Alan is afraid all the guy is going to start doing is debriding the ulcer (which he has already had done for 18 months).

And Alan does indeed make his own appointments and phone calls but believe me this morning, to get to the step I just got, it took me 2 hours, 5 phone calls to various places, two phone calls to his insurance company, etc. Alan would have thrown up his hands and gone crazy.

So I just did my thing. And we now have the appointment.

Thank god for that.

Melody

I think its the best way- initial appointment - say:
"he's been thru debriding & it hasn't been sufficiently helpful.
Bone shaving has been recommended.
Will you do it, if you think that's a sensible/practical/(you name it).... solution to his problem?"

Thank you Bob:

Tweaked it a bit. How's this??

"he's been thru debriding & it hasn't been sufficiently helpful.
Bone shaving has been recommended.

Is this feasible, in your opinion? And will you do it??

Thank you"


I think that's good. As a matter of fact, I copied, pasted and printed it out.

I have to memorize this.

Very good Bob.

Uh OH, Update. Alan just walked in the door from his podiatrist appointment (he goes every week to have it debrided).
The doctor gave him a letter to bring to the new foot guy.
Here's what it says:

"This patient has been treated for an ulcer submet 1 (R) since 4/06. He began an agressive work out regimin of cardiovascular fitness when lesion suddenly developed. Ulcer has healed from time to time, however it would eventually return as the tissue plantarly would continue to break down again perhaps due to boney prominance of plantar head of 1st metatarsal and/or sesamoid.

Ulcer was treated with weekly aggressive debridement, including betadine wet to dry dressing, Amerigel etc...

Recently a healing shoe was utilized but this also was unsuccessful.

We then suggested that Mr. Lubart try a wound healing center as another option. Please evaluate.

-------------------------------------------------------------------

His doctor also gave him his x-ray to bring to the new guy.
Also, Alan asked him "why would you not operate and remove the bone?" and the doctor replied "because there is too much of a risk to your big toe and it will throw off your balance, so we can't take the risk". Alan did not ask him "why can't you just shave the bone". I have no idea why Alan did not get a better explanation of why they can't shave his bone. Oh, The doctor did tell Alan, "one of the things the new guy might do is put you in a foot cast for two weeks. You'll be on crutches, but your ulcer will definitely heal.....but I'm afraid that once you start walking again, the ulcer will re-cur".

So off we shall go on Tuesday.
This shaving of the bone thing has me baffled. I know insurance companies don't pay a lot to these podiatrists, but if it was an option, shouldn't it have been thought of 18 months ago?? Or am I nuts??

Melody

I know time is an important factor but sometimes you can fight the insurance company to pay. It has never worked for me but I have friends who have and won or for them. I know for my procedure in OH they were not going to cover so the referral they gave me in MI I sent all my records and a letter stating that I was referred by that doc for the procedure but was also looking for any other procedures,therapy, or feedback that doc could give and I faxed all my records. Good luck to your husband. On the note of insurance companies I don't know why they have to make things so ruff sometimes. Its just adding to the issue.

Good, Mel!

Daniella,
It's simple. Ins cos are in it for the profit.....bottom line only.
I had a business liability policy with a (nameless) company for
4 years and had a claim because of theft.
It was covered. They paid. I thought they were "the best".

When it came time for annual renewal, they refused to renew
and dropped me. Reason they gave:

Policy premium per year - $550
Length of time covered - 4 yrs x $550= $2200
Paid out - $5,500.
"Sir...It is not financially feasible to renew, .....since we have paid out....
.........more than you have paid in"
(Go find another insurer, sucker!)

Hi Daniella:
As far as Wound Treatment Centers, this has nothing to do with the Insurance. The wound treatment centers bill as a clinic, and Empire Blue Cross Mediblue says all clinic co-pays are $50, no matter how often you need to go. Spoke to two different people at two different times, and got the same explanation. The insurance guy said "it's not us, it's how they bill, and they bill as a clinic visit".

I called all of them, and they all bill as a clinic visit. This is a different thing than if Alan needed a procedure, and they wouldn't approve of it. Totally different matter. So I made sure, I called Methodist, I spoke to the Billing Department, I spoke to the person in the Podiatry Department.

Alan's co-pay for any visit to a podiatrist is $15.00. So this tuesday, when he goes, he'll $15.00. And whatever the doctor recommends for him to receive, if it's done in the podiatrist's office, Alan will pay $15.00, however, if he needs a bone shaving, or any procedure done in the hospital part, Alan is covered 100 percent.

I did my homework on this one. You have to, when you are dealing with stuff, just out of the ordinary, like wound treatments, IVIG, whatever.

I just hope they can do SOMETHING. He's not diabetic and he's had this foot ulcer, healing and not healing for 18 months. We know why he has it (bone inpingement). Now whether or not this podiatrist throws up his hands and goes "oh no, we can't risk an operation, well, I don't even want to look at Alan's face if that happens".

He needs to go back to the gym and exercise. His PN didn't bother him when he was able to go to the gym and use their machines. He has to wait until this ulcer heals (if indeed it is able to heal). The only time he had any energy was when he went to the gym 3 times a week. He was a different man then. He hasn't gained any weight but he had more energy when he exercised. I tell him to sit in the chair and lift weights (we have dumbells), but he's very stubborn, (possible OCD issues here). He says "no, I have to do this at the gym".

Oh well.

Melody

Mel and Alan,
I hope the new foot dr. takes care of Alan's foot so that he can get on with life and not have to worry about it anymore! Medical problems cause such stress. They drive me nuts!
Mel you are great! Those dr.s and Ins. co. don't have a chance with you on the other end of the phone! LOL Good for you!!

I'm probably missing something,for this i apoloogize. How big has Alan's
sore been let's go by bigger then a siver dollar and how deep. Has it
ever gotten a terrible smell,i mean awfull. If you say it has staken a year
to heal and you never noticed a smell. Does Alan have ssi i as well as
the medicare?? I guess what i'm trying to say does he have Medicare
and ssi as his secondary insur. Has he been told his ulcer may need a
skingraft.
has his neuro,family Dr,or even a ER Dr. told you he needed to see a wound
Dr. When Bob's Podiatrist told him there was nothing more that he could
do he would have to see a wound Dr. he had to go through ER. They did
all the work. And my family Dr. got me in within a week. I was about to
loose my foot and so was Bob,i have never seen such caring Drs. with adults
and Children. I'm sorry Mel i've really been through it lately and if i'm rude
i'm sorry. One thing i need to do is use a micro because my hands will only
work for a very short time. I'm getting a new computer thanks to my family.
I guess all this stuff that has been going on has put me behind,honest i'm
sorry, Love Sue

Hi Sue:

Alan's foot ulcer is the size of a silver dollar. That is, after it gets debrided. He had an infection (that's when the ulcer got full of blood) and I told him "we have to get you to the foot guy as soon as possible. They took him immediately, put him on antibiotics and it cleared up in two days.

It always heals. And as soon as he walks on it, it comes back. It's caused by a bone impingement. It's a surface foot ulcer. No grafting, nothing deep. If he sat in the chair for two weeks and never got up, it would heal completely but who can do that?

Since the podiatrist knows that he can't go any further with Alan, he suggested a wound treatment center, but since we can't afford the co-pays, the next best thing is the podiatry department inside Methodist Hospital. They do bone shaving (what his podiatrist thinks he needs).
So hopefully, we'll go on Tuesday, and bring all the x-rays and report and the doctor will either say "yeah, he needs bone shaving", or he might say : "let's try this first". I really have no idea.

And Alan is not on SSI. Alan is on Social Security Disability. He worked all his life and paid into Social Security so he is entitlted to it. Then when he turns 66, it becomes automatic retirement.

I wish he could get SSI in addition. That way, we could get food stamps. But you have to make next to nothing to be eligible for a benefit card in NYC.

So we do as best we can. We've been lucky. Good doctors, good dentists.

Can't complain. Remember the saying "I cried because I had no shoes, then I saw a man who had no feet"????

Yesterday, I went for a walk, and I was thinking about what we are dealing with and then all of a sudden I see a guy in a wheelchair and his arms and legs were completely turned backwards. Never saw this in all my life.

He was just sitting in the chair and people were giving him money.

So I just said 'wow, I'm going for a walk, and this guy can't even get out of his wheelchair". Got me out of my pity party mood really fast!!!

Melody

Roxie:

How are you doing tonight?? Hope you're feeling stronger since the IVIG stuff!!

Well, I've been taking care of Alan for 27 years. I expect to be taking care of him for another 27 years. If I don't do it, who will?? (lol)

I'm so used to calling up insurance people, offices, etc. I learned to be courteous, and then grateful, when you get to speak to ANYONE. It's usually a lot of robotic voices until some live person comes on. Drives me nuts but I wait, and I wait, and then eventually, I get to speak to someone.

The annoying thing is when I know I'm right and the insurance company is wrong, and they say "well, I know you are probably right, but it's not coming up on my screen....oh, wait a bit....oh, here it comes....OH YOU'RE RIGHT!!!!

I want to pop someone on the head when that happens.

Oh, something very funny happened to Alan this morning. He must have gotten 5 phone calls in a row from various brokerage companies, mortgage companies and he was sick of saying "not interested".

So some guy calls and identifies himself as Martin Luther somebody or other, and starts to go into a speech about mortgages, and Alan said "oh my god, you're alive???" and the guy was thrown off track and said "I beg your pardon". and Alan started going on and on and I finally grabbed the phone and yelled "we are not interested now, nor will we ever be interested in any mortgage application".

I get at least 20 of these phone calls every day. Yuck.

Melody