SOUTH BRONX SCHOOL: Look, What GHI is Doing to my Hand

Saturday, February 25, 2023

Look, What GHI is Doing to my Hand

I just can't wait to get on Medicare (Dis)advantage with the issues I've been having with Emblem GHI the last month or so. BTW, that was sarcasm.

About a year ago I was waking up, as well as recurring throughout the day, with pins and needles in my left (dominant) hand and fingers. I assumed it was because of a pinched nerve in my neck and went to a chiropractor (Didn't need a referral and I recall when chiropractors weren't covered). I went for about a month and stopped due to it was getting better and I didn't have time anymore. 

But around late October, early November,  the symptoms came back. Worse. There was pain with the pins and needles. It would wake me up in the middle of the night. The numbness would take an hour to go away. So this time I went to a spine surgeon that I know of, Dr Jonathan Oren (The ABSOLUTE best! If you have spine issues, he can work miracles. Mention me to him and get a free glass of wine compliments of Lenox Hill Hospital) (He deals with. REAL spine issues, not fantastical spine issues. And, his office isn't in a storefront or a strip mall). Again, no referral was necessary. Good.

I was examined and x-rayed. Dr Oren not being some gonoff doctor saw nothing abnormal in my spine and suggested I see a hand specialist and also to have an EMG. Since I already have a hand surgeon due to an arthritis issue my left thumb that part was taken care of. I also made an appointment for the EMG.

So far so good. Notice I am in control of my healthcare. 

I went to the hand doctor. He gave me a diagnosis of Carpal Tunnel and Cubital Tunnel Syndromes. I was also directed to start PT at once. Better, I knew the place where I wanted to go! The same PT where I went when I had my shoulder replaced three years ago. 

I called and was told that they don't take GHI for hand therapy. Say what? Yep, that was true. In fact when I looked closer at the script, the doctor wrote I was referred for "occupational therapy." I found out a few days later that anything from the elbow to the hand is considered occupational, not physical, therapy. 

Reluctantly I reached out to several other PT centers and heard the same. None took GHI for occupational therapy.

But I got a surprise with my last phone call. 

It was not that PT centers did not wish to take GHI. They couldn't. Why? Because GHI does not cover occupational therapy. Yeah. It doesn't. I found out after speaking with the hand therapists where I am going now that GHI is the only plan they know of which doesn't cover occupational therapy. 

How am I rehabbing the hand? I was told by a hand therapist where I am now to have the doctor  re-write the script to "physical therapy." Instead of a hand (occupational) therapist working on me it will be a physical therapist. The PT I have now is fantastic and he gets his instructions for the hand people. How does this make sense?

I understand how complicated the hand is. I nearly sliced my thumb off cutting open a roll at Grand Union in 1984. I severed the tendon and nerve in my thumb and hand therapy helped quite a bit. It is proven science. But who knows how the powers that be think at GHI. I mean, who do we even bring this up or complain to?

Overall I have been happy with GHI. This story is like a gnat flying in front of my face at a picnic. But with Mulgrewcare it won't be a little gnat fucking around with our healthcare. It'll be a flying Mulgrewsosaurus right in front of us with it's hairy and pimply ass right in our faces.

I'm grateful that at no point have I had to get clearance to see a specialist, receive a test, or go to PT (though with PT one needs to re-certify after 16 visits). I am grateful that I spoke with someone who told me how to get around the system. 

But to deny occupational therapy for whatever reason is mind boggling! What happens is someone else didn't have the resourcefulness, guile, or perseverance I have? That person just might wind up with an atrophied, useless hand. This is one of the inherent dangers of Mulgrewcare. How many will be told "no" and just accept that? 

Seven months after total shoulder replacement I was swinging a golf club again. Eight months after I was playing a round of golf. Will I, or anyone else, be able to have access to world class physical therapy on Mulgrewcare? Or even the surgeon who operated on me?

If I have to have surgery on my hand, I'll be damned if I won't be out of a golf course no more than six weeks after surgery. Again, I'll have top notch PT and a surgeon.

Fix the healthcare. Give us occupational therapy. Give us what we want. Don't fix what is broken. 


Christine Larsen said...

Yes, Peter; hand therapy is a specialty occupational therapy. I had to go for hand therapy in 2015 -2016 and it was a pain in the neck to find a place that took the city's insurance. I had to travel far to a place in South Ozone Park that specialized in hand therapy and was only approved for a set number of visits.(GHI) Then after I left the doe and started using my husband's insurance from 32Bj (union plan), I was able to go to a hand therapist much closer to home in Elmhurst. I am more in mid-west Queens and South Ozone Park is pretty far out of the way for me. The hand therapy did help as I was diagnosed with arthritis in my left hand. I had tingling pain across the top of my hand. They even made me a brace at the therapist clinic. I hope everything goes well in your care for your hand.

Anonymous said...

FYI…my husband had a catastrophic illness a few years ago, and needed PT, OT and Speech therapy. GHI denied the OT, but Blue Cross covered it.

Pete Zucker said...

Christine-Thank you for your support and sorry about what you had to endure.

@3:15; Was his OT outside of a hospital?

Anonymous said...

The first round was located inside NYU Langone, but he was seen as an outpatient. The second round was at a Select Physical Therapy, and Blue Cross covered that too. The codes they use make a difference.

Profits Over Dignity said...

GHI does not cover OT because it would be yet another service they'd have to pay out for. Less paid out is more profit for them. Your illnesses and vulnerability exist for them to profit on. Wake up and smell the evil accepted as normal. If we start asking for dignified healthcare, such as what you're suggesting, we'd be betraying our country, our flag, our men and women in uniform who fought for your right to voice yourself, and we'd be labeled as hippie communists and socialists. What were you thinking?!