Filing medical insurance claims...More favorite photos from the past 14 months...


Tom and I at my birthday party at Jabula Lodge & Restaurant.
"Sighting of the Day in the Bush"
From this site:  The Katydid leaf bug:  Katydids get their name from the sound they make. Their repetitive clicks and calls sounded like someone saying, "Ka-ty-did", so that phrase became the common name. Both genders are capable of producing the sound. Katydids are related to crickets and grasshoppers, with large back legs for jumping. Unlike grasshoppers, Katydids have extremely long, thin antennae. Unlike crickets, their bodies are more rhomboidal, like a kite with four equal lengths. They have wings and will fly away from danger. Most sightings occur when they land on an object and linger. Some have even gone on car rides, clinging to the hood of the vehicle."  Great photo, Tom!
It's hard to believe it was 14 months ago that we celebrated my 70th birthday with friends at Jabula Lodge & Restaurant where so many magical nights with friends transpired.  It was a memorable evening I will always treasure as one of my favorites.

Living in Marloth Park for an extended period had been my dream after leaving here over five years ago during the first few years of our world travel journey.  While in Sumbersari, Bali in 2016, Tom surprised me by telling me we could return to Marloth Park for my 70th birthday.  I was ecstatic.
Within weeks we had revised our itinerary to include this lengthy visit, never intending it would go beyond one year when the unthinkable happened and I had to have triple bypass surgery before we traveled to any other countries.
My 70th birthday cake made by a local Marloth Park baker.
Based on the fact that living in South Africa is more affordable for Americans than most parts of the world, we felt we could "lick our wounds" from the expensive Antarctica cruise on which we'd embarked on January 23, 2018.  When the cruise ended we headed straight to Marloth Park.

Little did we know, at the time, that we'd be here months after our anticipated "moving on" date which was planned for February 15, 2019, based on requirements made by immigration.

It was a good plan.  At the time we had no reason to believe our whole world would topple upside down tossing plans to the wind while losing tons of money for prepaid and prebooked venues to include flights, cruises, hotels, and tours.  
Kathy in the foreground, Ken in the background.
Fortunately,  we didn't have to cancel any holiday homes during this period and furthermore, Louise was able to accommodate our extended stay in the Orange house for three more months than expected while I'd recover.

So, my dream of spending my 70th birthday and ultimately more time in Marloth Park was fulfilled.  Little did we know at the time, that I'd spent my 71st birthday in the ICU of a small South African hospital.  I hardly remember that day.  

It had only been a week since I'd awaken in the recovery room, the second of four times in a few months, intubated, struggling, and in massive amounts of pain.  How did I ever get to this place?
Mick at the end of the table.  Look at that great plate of food; steak, butternut, and creamed spinach.
Now, almost nine weeks since the bypass surgery on February 12th, from which I've recovered well except for my legs, for which I continue to struggle with pain, discomfort, and frustration. The slow healing of my infected legs for which I had to return to the hospital for five more days and have two more surgeries has left me wondering when I'll be able to walk again without pain.

Over my head, these past weeks has been the frustration over getting the insurance company to pay the ZAR 700000, US $50,223, to the hospital for the major of the four operations for which they've only paid a portion at this point.

Remaining unpaid now is the balance on the bypass surgery and our prepaid costs for the overnight stay in the hospital for the angiogram at ZAR 80000, US $5740, and the subsequent five-day hospital stays for two surgeries on my legs at ZAR 130000, US $9327.  
My large Greek salad.
With a ZAR 27876, US $2000, copays required on each of the three above hospitalizations, the insurance company owes us ZAR 210000, US $15044  less the two deductible amounts we paid out of pocket, leaving a balance owed to us for ZAR 154,250, US$11067. (We'd already paid the copay on the bypass surgery).

Based on the insurance company's lack of cooperation in paying the claims, we're not optimistic we'll see reimbursement on any of these claims.  Regardless, of our speculations today, I started the process of filing the claim for first, the angiogram, and secondly for the leg surgeries and additional five-day hospitalization.
Our friend Dawn, owner of Jabula and her server bringing in the birthday cake.
We didn't want to file the angiogram claim until we knew the bypass surgery amount had been paid.  Trudy, the knowledgeable and helpful billing manager at Mediclinic Hospital, did everything she could to assist in this process.

I have forwarded the portion of the form to be completed by the cardiologist and returned to us via email.  Once we receive this we'll be able to submit the completed forms for that portion.
Staff and friends singing the birthday song.
Right now, we're awaiting the total bill for the hospitalization and two surgeries on my legs.  Once we receive this, we can file the claim for this portion.  Oh, my, the paperwork.  

We often wonder how seniors and others who don't have access to technology or who may find this type of paperwork difficult to comprehend and complete, could possibly handle the necessary processes.  It has taken me weeks to gain sufficient motivation and clear-headedness to feel like doing this but a 90-day timeline to file the first claim is hanging over my head which ends on May 10th.

I would have started this sooner but I needed to know that the bulk of the bypass surgery was paid.  I found this out on Friday, a few days ago.  Now we're able to proceed.
Danie to the far left, Lynne bending down, Don at the head of the table with Ken beside him.  Louise and Linda were there but not in the photos.
When I think of all the receipts I've yet to record and scan before we leave here in 26 days, I cringe.  But once these insurance claims are done, I will begin the painstaking process.  Under normal conditions, I record receipts every few days but lately, that hasn't been on my radar.

Have a great start to the week and be well.
_______________________________________

Photo from one year ago today, April 15, 2018:
A southern ground hornbill we spotted in Kruger National Park.  For more photos, please click here.

0 comments:

Post a Comment