To Whom It May Concern:
I am writing on behalf of myself in regards to claim #[…].
I must preface this letter by saying how deeply saddened and frustrated I am with the current system in place. For a person to have to jump thru hoops to receive doctor recommended care is simply unacceptable.
On April 5, 2013 I was denied additional physical therapy appointments in regards to severe neck pain I have as a result of a C5- C6 cervical spinal fusion. I was denied therapy in December 2012 but it was brought to my attention that I would be granted “immunity” during the new year of 2013. I fought the first denial but nothing came of it because of the New Year and my ability to receive 8 additional visits come January 2013. I did as was suggested by Blue Cross and waited until January to continue physical therapy.
Now, it is May and I have been denied, again… the New Year can no longer grant me immunity.
Now, let’s think: big picture…
What baffles me the most is the fact that Blue Cross Blue Shield paid to have a metal plate put in my neck, yet refuses to cover follow-up medical treatment as a result of the initial surgery because, as stated in my most recent denial letter, I was not making significant enough progress. From an insurance perspective, this seems counterintuitive; it would be assumed that a health insurance provider should be concerned with my inability to improve in the “allotted” (whatever that means) amount of time. What also upsets me is the fact that as “health care providers” (this is in quotes because it is apparent my best health interest is not first and foremost here, as a health care provider would demand) should know that cervical spinal fusions require upkeep and reconditioning. Because the vertebra are unnaturally fused, the body combats this by tightening up surrounding areas as a compensation technique thus requiring therapy after initial recovery[1]; essentially (as you know), the discomfort I experience is the body’s continuous reaction to having an immobile foreign object in place of vertebra (sounds cute when I put it like that).
When I most recently called to “fight” this denial, I was told I had not used any of my chiropractor visits for 2013, to which I laughed at. It had been brought to my attention before my surgery (in 2007) that under no circumstance was a spine patient to undergo chiropractory, as risk for paralysis is exponentially heightened. I shutter to think of trying to get treatment for that approved… I digress…
All jokes aside, the big picture here is that I am currently in a great amount of discomfort. If I was to rate it (like any doctor, physical therapist or specialist would ask), my pain ranges from a 3 on good days to about an 8 on those really bad ones- I am rarely, if ever totally pain free. My hands have started to experience numbness and my sleeping has been disrupted as a result of my pain. This affects my fulltime work and my ability to stay physically active, which as a “health care provider” you know is incredibly important to my mental, social and physical wellbeing.
You are getting this whole “saga” because I refuse just to be a number in the system that has called and complained… still to been denied. I refused to be judged by a “professional” board (if this is the fate of the United States, I am moving) that does not know me, has never seen my x-rays nor my scar, let a lone felt the knots and tension in my neck, upper back and midsection that are a result of my C5-C6 fusion.
I am not going to go away because, well, thankfully my neck is still attached to my body. Both of “us” have needs that need to be addressed and I plan on achieving success both with you, approving additional therapy visits, and with my treatment plan as provided by my doctor and physical therapy team.
I do expect receipt upon arrival and for this to be resolved in a timely manner.
Thank you for your attention to this,
Samantha
p.s go fuck yourself… and rub my neck.
Sherman, John, MD. Spinal Fusion Surgery Recovery. http://www.spine-health.com/treatment/spinal-fusion/spinal-fusion-surgery-recovery-three-months-and-after
as almost all of you know, i have started catering and bartending. i keep joking that it’s a good way to “learn about humanity” (which it is), “learn about myself” (couldn’t be more accurate) and of course supplement the shekels i make working a job i really do love.
well, last night i came to the realization that this customer service based, smile all the time, call people ma’m and sir (even when they’re younger than you) and over your dead body swear industry… just isn’t for me. though i have taken a rather liking to the clogs (they’re shiny) and have gotten really good at tying ties and taking pictures of myself with a double chin in said tie and have even made friends (sometimes i don’t play well with others), I can’t say i have the patience (or inherit skill-set) to do what is always asked of me. examples are as follows:
1. i spilt red wine last night. i didn’t drench anyone (though the d bag would have looked better with a red spatter on his ugly shirt), but after a little splash on the white table cloth, i couldn’t even find a napkin… and i didn’t care.
2. my patience for certain people is non-existent. as i went around “wine-ing” (aka giving people wine) last night, i get to a certain table of racially ethic individuals. it had been previously brought to my attention this group of people do NOT like ice in their drinks and have a tendency to drink a lot of juice. well. i go to the first woman (ok girl, let’s cut the crap, she was maybe 19):
me: “would you like red or white with dinner?” (fine, she was maybe 21 if she was getting wine but my stuffed animals looked older than her)
her: “do you have any juice?”
me: (with a painful grin) “cranberry and orange”
her: “orange juice… NO ice”
i put down the wine, and go retrieve the orange juice (but of course, i put ice in it. i need the upper hand somewhere)
next person, me: “white or red with dinner, dinner is salmon”
person: “oh, ill have a cranberry juice, no ice”
i clunk my heavy ass clogs back outside to the bar to get a cranberry juice, of course putting ice (and a lime!!) in the glass.
next person, me: “white or red with dinner.”
person: “oh, i’d love an orange juice, NO ice.”
well by this point, i have fuckin HAD IT. instead of shutting my mouth and proceeding in this blood boiling pattern, i cut the shit and announce, “ok, if you want cranberry juice, raise your hand. now, OJ.” these harvard (assholes) look at me like i have madusa coming out of my head, but they don’t realize, i am 100% serious that this “juice game” is donzeo.
i stomp out of the dining room, please with myself as i steal a crab cake off the appetizer plate and check my phone.
3. perhaps i don’t speak clear enough. as dinner came to a close, i was in charge of serving REGULAR COFFEE. there was a girl behind me with decaf, and a guy with tea… i go to the forbidden juice table and we announce our options…
after we came to the realization this would be a tea only table (can you guess where these people are from), after offering each of them REGULAR coffee to them saying “i want tea” (no please or thank you) i go back to the kitchen to get the tea box.
person: “oh, you don’t have black tea”
(i had to catch myself from saying, no, i’m hiding it in my bra for myself)
me: “no, ma’m we only have these selected teas”
person: “oh”
me: (go fuck yourself)
this continues THE WHOLE WAY around the table as i’m schleping a tea box and someone else has the hot water.
4. i can’t carry a tray on my shoulder. with a neck like this, i’m lucky i can lift my arms, let a lone, keep my head upright… and these people want me to carry a tray? HA!
oh the saga of being customer facing…
thank you for being my best friend.
thank you for teaching me to love and be loved… and strongly dislike too…
thank you for teaching me to have some (ok, a lot of) sass and always to speak my mind.
thank you for listening to me when i babble (and even when i make sense some time).
thank you for being my sounding board, life or work related.
thank you for always taking interest in what i am doing; from retail to bartending and beyond, the newspaper articles you highlight (just like pop) for me always make me smile.
thank you for not talking to me in the morning, but always having the yogurt and coffee ready.
thank you for sharing your love of all things pretty (and delicious) with me.
thank you for always thinking about my waist line (and esophagus, hello, hot sauce). i hope i shrink as i age too…
thank you for sharing your closet with me.
thank you for everything and more… in a nut shell: thank you for being you!
love you this and every day, best friend!
when older people think new is weird and unnatural.
i was just told (by an 65+ older white male) that he thought i would be great with this client he doesn’t connect with because i think SOOO (this was really stressed) differently than anyone he has ever met in the industry.
of course, i have the best filter around and my response was “you can call me SPED but the fact of the matter is, i represent new-age retail and am most brand’s target market, so you should probably get on my level”…
oops, respect… out the window.
it really baffles me that in an industry like retail (where changes happen quickly and very on track with what is happening in the world- i.e, technologically and in regards to brand marketing, etc.) that older, white males (who totally smoke cigars and drink malt liquors) can still have such a stake…
im not asking for everyone to jump on the curated, creative, social media, speak your feelings bandwagon (the latter is something i am very much opposed to, as you know), but, dudes, my generation is the majority of the worlds population, so you have more bones to pick than just one with this curly (tonight, straight) haired jew.
tomorrow is may 1st, which means that it almost marks one year since i have graduated college. wow. graduated… college? me???
i was reflecting earlier as i sat in the backyard working from home, basking in the sun wearing cheetah print sunglasses and crop pants that had a little too much flair about how overwhelmed and underwhelmed i am by this first year post graduation. then ozzi barked angrily at the UPS man that wasn’t delivering my anthropologie pants and i was brought back to reality.
I will tell almost anyone i meet, i was under the assumption that after graduation my laundry list of questions would be answered in a rather timely manner. my relationship status would change from “single” to “happily in a relationship” and the first job i took would be the one i fell in love with…. can i get an LOL. when it boils down to it, i thought the world would resolve itself because I had my college degree. once again, LOL.
it’s amazing to think the places i have been, and what i have experienced in the year since graduation. again, totally overwhelmed and totally underwhelmed.
i started at reebok soon after turning my tassel and was shocked to find myself fighting back tears almost every day of my first week of work… by the end of the week, i could at least compose myself to get to my car, call nanc and then start tearing up… but man, can you say reality check. it was the first time since my freshman year of college i couldn’t make a friend to save my life and i looked forward to reading because it was an activity i could do by myself. It wasn’t until probably a month into work that i ate with someone not at my desk. i knew this wasn’t the path for me, doing swivel chair abs and listening to emo music in noise canceling headphones, watching the day go past me without *meaningful* or exciting work… not exactly an ambitious post grads dream. my new goal became making it to the 6th month mark to be able to say “seeya, suckers”.
the glamor of post grad continued to pile up as i found myself looking for any sort of international work to get me the f*ck out of where i was… living in madrid answered a lot of questions, part dos anyone? well, apparently studying abroad and working abroad are different and my “boyfriends” in the tapas bar of spain have yet to see me again.
leaving reebok in december was liberating and nerve-wracking. i left a job without having another lined up which could have (and should have) been a recipe for disaster. in some “sammy way” (as dan says) i had 2 offers before the 2nd week into the new year. i turned down the job everyone thought i was going to take and left for bartending school in Tampa the next day. I arrive and Matt doesn’t even ask my decision, he already knew what I wanted to do… if only he had told me that days earlier as i made myself sick contemplating the “just” world of social service and the seemingly sensible decision of joining the business world… i was worried about becoming a “suit”.
here i am, on the eve of may and i am relieved to say, i am happy with my job (and the sweat pant perks) but the list of questions does continue to build. i have started catering (hey there, glam post grad living), and yes, i still live at home.
if you were to tell me a year ago on this day that in a year, i would be making only enough money to fill my car with gas and buy a couple rounds of beers, that i lived at home and started bartending and catering to make a little extra dough, and that my big “life” questions were all still unanswered, well, i would have laughed in your face… all your questions get answered when you shake with you right and receive with your left…
As if, bro. You need a reality check.
xoxo
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we are not just americans.
we are bostonians.
we are strong.
we are stubborn.
and despite all adversity, we will prevail.
(Source: amour-et-hommes, via briannegrace103)
“We will persevere. As Bostonians – which we ALL are on Marathon Monday, native or not – we are strong, stubborn New Englanders to the core.”