How You Can Help Peter David Right Now

[MagSeven]

Here we go....

Do I have to provide another primer on how health care and health insurance work?

First, he suffered the stroke on 12.30.2012. Out of pocket patient liability is applied based on admission date, not discharge date. So if all out of pockets were met in 2012, they won't be applied to a claim that straddles 2012 to 2013. Now if the family (or individual) hadn't met all of their out of pockets in 2012, that's a different story.

I assume he's still inpatient and will be moved to inpatient rehab, if he hasn't already.

Also, what the Hell kind of plan do they have if there are services -- related to the stroke diagnosis -- the insurance won't pay on?

Inpatient rehab (in a skilled nursing facility, a rehab hospital or the rehab wing of an acute care hospital) is a standard inpatient ancillary benefit.

Speech, physical and occupational therapy are standard services and their co-pays usually fall between $15.00 to $30.00 a visit. They may be covered with a limit -- most likely 30 visits per benefit period -- but if more are needed, they need to go right to a medical director at the insurance company and request an exception to have more visits added.

So what services does his wife think aren't covered?

Probably personal things which are really none of our business. The explanation she gave in the article is good enough for me. I'll check out the Vampire book as my way of chipping in. Small price to pay for all the enjoyment over the years. I'll probably end up liking the book too, so bonus. I also seriously doubt PAD or his wife are out to screw us.

[CaptObtuse]

I also seriously doubt PAD or his wife are out to screw us.

Exactly this. What possible motive could the Davids have for trying to run such a high profile scam? Especially when they're "rich enough to go to Disney."

Again, I don't know which is sadder: Peter David experiencing first-hand what's wrong with healthcare in this country, or the anonymous cynics of the Internet who can't accept this as a family's personal struggle and either decide privately whether they're in a position to help or not.

[DJ_Convoy]

No one's holding a gun to your head. If PAD has brought you some enjoyment over the years, buy a book or two to help a brother out. Jesus.

[Appasawz]

Here we go....

Do I have to provide another primer on how health care and health insurance work?

First, he suffered the stroke on 12.30.2012. Out of pocket patient liability is applied based on admission date, not discharge date. So if all out of pockets were met in 2012, they won't be applied to a claim that straddles 2012 to 2013. Now if the family (or individual) hadn't met all of their out of pockets in 2012, that's a different story.

I assume he's still inpatient and will be moved to inpatient rehab, if he hasn't already.

Also, what the Hell kind of plan do they have if there are services -- related to the stroke diagnosis -- the insurance won't pay on?

Inpatient rehab (in a skilled nursing facility, a rehab hospital or the rehab wing of an acute care hospital) is a standard inpatient ancillary benefit.

Speech, physical and occupational therapy are standard services and their co-pays usually fall between $15.00 to $30.00 a visit. They may be covered with a limit -- most likely 30 visits per benefit period -- but if more are needed, they need to go right to a medical director at the insurance company and request an exception to have more visits added.

So what services does his wife think aren't covered?

You correct in all your facts but it can vary widely from state to state and health plan to health plan. I have what could be considered an above average plan. My daughter had a stroke at birth and 4 years later some of the bills I'm responsible for are obscene. Your plan can also penalize you for getting care outside of their network by paying less, but the bill is the same. Fortunately there are centers that do remarkable things for stroke victims. You have a top notch one right there in Philly. Unfortunately, insurance companies like to view you taking your daughter to Boston, Philly, Detroit and Baltimore as more expensive to them. For the curious, NYC in my great state of NY has excellent care but finding a good doctor there that isn't booked for his career is like playing the lottery. That's also with her having Medicaid as a secondary.

All the insurance/government criticisms aside, I hope Peter seeks nothing but the best care and has as much or more success as I've found. It's a weight on the mind but they can only get so much blood from a stone. We at least get to disappear into worlds created by guys like Peter when things get rough.

OK end of sermon. Back to being a bit of a sarcastic dick on some other thread.

Get well, Peter!

[HellBlazerRaiser]

I know how benefits work and I know how they vary from plan to plan, state to state, etc. I've work in the healthcare industry -- payer and provider sides -- for a long time now.

My point every time a thread such as this pops up is that there are things patients can do -- ways for patients to get more for their money (their premiums) and more benefits than they may be aware of.

[Peter J Poole]

So what services does his wife think aren't covered?

No idea. Also, don't care.

From experience, however comfortable you think you are and how well covered you think you have the bases, when the wolf bites it's gonna hurt like a bastard.

If you like PAD's work and his contributions to the industry, this is a small way to pay back the pleasure you've had.

If the BC default link settings offend you, go direct to Amazon. Or your LCS/bookstore if you have one.

If you don't want to chip in, fair enough.

A festival of uninformed fanny-bashing on the matter, probably not required folks...

Cheers

[HellBlazerRaiser]

My point is that the man has options.

There are avenues patients can go down where they can obtain exceptions to the basic benefits and other options to ease the financial burden.

[Scavenger]

My point every time a thread such as this pops up is that there are things patients can do -- ways for patients to get more for their money (their premiums) and more benefits than they may be aware of.

If you have actual helpful suggestions and recommendations, send them on to Rich or me to pass along to Kathleen. If you're just being a forum know-it-all douchebag, well I guess keep posting.

[Scavenger]

2x Post 2x Post

[CaptObtuse]

My point is that the man has options.

There are avenues patients can go down where they can obtain exceptions to the basic benefits and other options to ease the financial burden.

And perhaps they've explored those options and didn't qualify. And perhaps they've already exhausted those options for which they are qualified. And perhaps they prefer to be self-sufficient and earn the money they need through Peter's work. And perhaps you don't have all the facts.