b"COMMUNITYLet You Tell ItPlansfailforlackofcounsel,but with many advisers they succeed. Proverbs 15:22 (NIV) By Maya Wheeler, Community AdvocateO penenrollmentforMedicare begins on October 15th and ends on December 7th for the 2020 cover-ageyear.Haveyoustartedthinking aboutwhatplanmayworkbestfor you? Until September 25th, I never gave muchthoughtabouttheannual Medicareenrollmentperiod,because Iamnotmedicareeligible(i.e.not 65andolder,disabled,orhaveend stagerenaldisease).However,on Wednesday,September25th,2019 this question turned my world upside down. I was not medicare eligible butMaya Wheelermy mother was. On Friday, September 13th I received a call from my mom stating that sheprocedure that cardiologists, or heart was experiencing extreme pain on thespecialists, use to evaluate heart func-rightsideofherbody.Sheinformedtion and diagnose cardiovascular con-me that I needed to come to her houseditions. right away. Upon arriving at her home,Once,theprocedurewascomplete she told me that I needed to go pickupmy family and mother where in total a prescription for muscle relaxers forshock.Theprocedureshowedmost her. So I didn't really think too much ofofmymom'sheartarterieswhere the situation and thought she was overblockedandshewasonherwayto exaggerating.havingaheartattack,ifimmediate However,onMonday,Septembersteps where not taken to unblock her 16th when the pain did not go awayheart arteries. So my mom went from andmymom'sprimarycaredoctorthinking she had strained her muscles said, she needed to go to the emergen- on the right side of her body to needing cy room. The situation became a littlea triple heart bypass surgery. more alarming, because my mom hadBythegraceofGodandmany been generally healthy my entire life. Iprayers the surgery went well and my had always been the person in my fam- mother recovery is going well. However, ily with health problems and my momanewproblemaroseonSeptember had been the rock in my life who had25th when the hospital was ready to helped me keep everything together.discharge my mom. Well things were about to take a 190Wehadbeentoldsincemymom's degreeturn.OnceattheemergencysurgeryonSeptember19ththatshe room,thedoctortoldmymomtheywould be going to inpatient sub-acute were going to admit her and give herrehab. However, now we where being astresstest(i.e.atestthatshowstold my mothers insurance was deny-how your heart works during physicaling the doctors request to send her to activity)thenextmorning.However,rehab. thenextmorningthedoctorsaidit wouldprovablybebetter,iftheydidInstead the insurance company was acardiaccatheterizationinstead.AsayingshedidnotmeetMedicare Cardiaccatheterizationisamedicalguidelinesforinpatientrehab.They were saying she was able to discharge homewithmeandhomehealthcare even after the heart surgeon was stat-ing that she could benefit from skilled nursing and therapy prior to returning home. I was shocked. I could not believe a So my mom wentinsurance company would deny their member the opportunity to go to rehab from thinking sheafter open heart surgery. I immediately went into react mode. I had strained herwent to the hospital staff and let them know my concerns and explained that muscles on theI could not be my mom's primary care-giver. I did not have a support system right side of herin place to make her discharge home successful,becauseIwouldhaveto body to needing aleave her alone for long periods of time and I did not have anyone who would stay with her in my absence. triple heart bypassI called my friends and family who surgery. workedintheindustryandasked whatmyoptionswhere.Iwastold, Ishouldcallmymother'sinsurance company and ask why she was being deniedinpatientrehab.SoIdidand I filed appeal with her insurance and Continued on Page 1710 OCTOBER 2019 BOCNEWS.com"