*Update* Surgery Scheduled Sept 6th

[Windsong]

Jim. don't you find this entire 30 day thing for recovery and back to work MOST strange?

I find it exceedingly strange.
Maybe this was some some sort of form letter from some sort of binder of "return to work" suggestions for things like oh, an appendix op, maye a heart op, oh maybe some rearranging of toe bones or some such thing??? Like a decompressed brain stem is in the same league?


How on earth can a company who owns  some health place who say they do An ops say ya gotta do the op here and ya gotta be back at work in 30 days or ya better "volunteer" to be gone and your job is gone? That is all totally bizzarre..........

W.

[Battyp]

Since there seems to be much debate on Renee's video. I personally emailed the producer and asked about that statement.

His reply, What I can tell you about the 2 weeks; is yes, that's what she told me and I believe the doctors concurred. She was in pretty rough shape.

Send me your email and I'll forward it to her so the two of you can create some sort of conversation.

I wish you a continued healthy recovery and lots of beach yoga in your future.

Todd"

I have sent my email and truly hope to talk to renee. Adrain, postivie note her face at the three year mark looked much improved. I was in aw that she was doing yoga at the beach. I have difficutly with shifting unstable surfaces and used the beach to help retrain my vestibular.

The work thing is awful!  I thought my company was bad. I sent you both and email. Go to my florida.com
here's the link: http://www.myflorida.com/accessflorida/

and apply for public assistance based on your medical situation. You can qualify for a share of cost plan to help with your medical needs, depending on your income you can qualify for other assistance. This is the time you take what is out there. Please know if I can help I'm a phone call away, an hour by car and have learned the system in the last two years with my situation.

Hang in there, this too shall pass unfortunatly not without stress and frustration!
Sending prayers and love your way,
Michelle

[Samantha n Adrian]

Thanks Michelle for the information. It looks like we will need to look into to that for sure.

Here is the bad news I received from the lawyer....

If Adrian has worked for at least 12 monthsand have at least 1,250 hours of service during the  12 month period, he would be eligible for Family Medical Leave (FMLA). But if he does not meet those two criteria, then he is not entitled to  FMLA. If he does qualify, then he would be entitled to twelve weeks of unpaid FMLA leave which would be inclusive of any vacation or Paid Time Off  (PTO) benefits...as most companies require that the PTO be burned off at the beginning so that there is not 12 weeks of leave and then vacation, sick time, personal days, etc. added on.

If Adrian has not worked there for 12 months, that being the case, they don't even, by law, need to give the thirty days that they have granted as "leave of absence."  There is no Florida law requiring a medical release, but all company's have a policy requiring it, and that is reasonable. They need to be sure that on return he can perform the essential functions of the job with or without accomodation safely. One thing that can change the dynamics of this, and I hope this is not the case, and that would be if he ends up with a disability covered by the Americans with Disability Act which would require them to go through an accomodation evaluation. That does not mean that they have to grant an accomodation, but if there is a reasonable accomodation, then they are required to offer it. If the accomodation would be unreasonable....expensive or causing disruption, etc. then they do not have to offer it.

Whether they offer part time work is strictly up to them as they are not required to offer it unless, ADA would consider it a reasonable accomodation.

The insurance matter is another thing...if you go out of network you will put yourself at risk...as insurance companies have a lot of discretion when that happens..and that it not good for you...so you will have to have their sign off if you go out of network. You don't want to end up having to pay for it yourself.

I am sorry to confirm bad news.

H. Middlenton

Pretty much the same as Jim Scott posted earlier. (Guess you've done your homework)

I am shocked that the laws do not do more to protect this sort of thing from happening to people. As far as I am concerned I am confident Adrian can find another job after he has recovered and I do not want him worring about trying to be fully back on his feet in 30 days. How can someone truly  recover when they are watching the clock ticking as to how long it needs to take? He does not need that added stress all that will do is frustrate him if it takes longer than 30 days and I do not want him doing harm to himself by trying to rush back to work if he truly is not ready.

But this is not going to get us down. We will have that surgery on the 6th regardless of this. We will find a way and we will be ok.

Sam~

[Crazycat]

Hey Adrian,

  You sure are going through the ringer. Sounds like what I went through. I had no time to spare. I was in the hospital immediately for shunt surgery and then had to wait a month for the tumor resection. You'll get through. It's a good thing you've stayed in shape over the years; that will help you during your recovery. Sept 6th is coming up fast. Soon it will be all behind you. Let me know if you need to talk......Oh and  by the way, I'm flying down to Tampa from Boston to visit my girlfriend Sept 11 (oh no!!!! I just realized it's on 9/11!!) through the 18th. Maybe (if I survive the flight) we'll come to visit you in the hospital!

                             Paul

[Windsong]

Again, Hi Sam and Adrian,

I hope this get settled soon.This is really hard fior anyone to deal with on top of being told they have an An and its size....


whatever you are getting from the ins co party(ies) pls do understand that the finickity details, side issues,  etc etc etc from them are simply there to sidetrack you....... most likely meant for you to scramble around dealing with minutiae (sp) that they stick into even one letter.... stay on track..... stay on what it is you want/ need/have been advised re that An ....
it was a really hot muggy day and I was pretty tired when i wrote  so i came back to delete some of my ramblings lol.... sometimes i can get pretty steamed over ins co, bureaucracy and really feel for anyone who has to deal with that sort of thing....

take care and  all the best.
windsong

Thanks Michelle for the information. It looks like we will need to look into to that for sure.

Here is the bad news I received from the lawyer....

If Adrian has worked for at least 12 monthsand have at least 1,250 hours of service during the  12 month period, he would be eligible for Family Medical Leave (FMLA). But if he does not meet those two criteria, then he is not entitled to  FMLA. If he does qualify, then he would be entitled to twelve weeks of unpaid FMLA leave which would be inclusive of any vacation or Paid Time Off  (PTO) benefits...as most companies require that the PTO be burned off at the beginning so that there is not 12 weeks of leave and then vacation, sick time, personal days, etc. added on.

If Adrian has not worked there for 12 months, that being the case, they don't even, by law, need to give the thirty days that they have granted as "leave of absence."  There is no Florida law requiring a medical release, but all company's have a policy requiring it, and that is reasonable. They need to be sure that on return he can perform the essential functions of the job with or without accomodation safely. One thing that can change the dynamics of this, and I hope this is not the case, and that would be if he ends up with a disability covered by the Americans with Disability Act which would require them to go through an accomodation evaluation. That does not mean that they have to grant an accomodation, but if there is a reasonable accomodation, then they are required to offer it. If the accomodation would be unreasonable....expensive or causing disruption, etc. then they do not have to offer it.

Whether they offer part time work is strictly up to them as they are not required to offer it unless, ADA would consider it a reasonable accomodation.

The insurance matter is another thing...if you go out of network you will put yourself at risk...as insurance companies have a lot of discretion when that happens..and that it not good for you...so you will have to have their sign off if you go out of network. You don't want to end up having to pay for it yourself.

I am sorry to confirm bad news.

H. Middlenton

Pretty much the same as Jim Scott posted earlier. (Guess you've done your homework)

I am shocked that the laws do not do more to protect this sort of thing from happening to people. As far as I am concerned I am confident Adrian can find another job after he has recovered and I do not want him worring about trying to be fully back on his feet in 30 days. How can someone truly  recover when they are watching the clock ticking as to how long it needs to take? He does not need that added stress all that will do is frustrate him if it takes longer than 30 days and I do not want him doing harm to himself by trying to rush back to work if he truly is not ready.

But this is not going to get us down. We will have that surgery on the 6th regardless of this. We will find a way and we will be ok.

Sam~

[Battyp]

Sam and Adrain,
 File for ssi though social security, and children and family services for the rest. If you two live together you are not family, adrian is his own person. So when it asks for "family or household" answer just for Adrian. Hope that helps. Sometimes the system truly sucks!

I know there is help out there it is just a matter of finding it and knowing the rules.
Also, keep in mind that after surgery Adrian can apply w/ vocational rehab which will help with any accomodiations, schooling, hearing aids, and educating his employer and helping him obtain employment if needed. They have paid for my hearing aids, and a masters program to help me get back to work.

Also, I have gone to the my house representative to fast track some of my paperwork. They have been great at helping navigate the state system.

Go rattle those trees until all the benefits are upon you and Adrian!
I'm here if you need me.

M

[Jim Scott]

I am shocked that the laws do not do more to protect this sort of thing from happening to people.

Politicians write the laws and businesses are major contributors to politicians.  So, when the interests of business and ordinary Americans are in conflict, the ordinary American usually ends up losing.  Hence, the 12 months employment/30-days stipulation in the law that applies to Adrian's situation.

As far as I am concerned I am confident Adrian can find another job after he has recovered and I do not want him worring about trying to be fully back on his feet in 30 days. How can someone truly  recover when they are watching the clock ticking as to how long it needs to take? He does not need that added stress all that will do is frustrate him if it takes longer than 30 days and I do not want him doing harm to himself by trying to rush back to work if he truly is not ready.

I agree.  Full recuperation time-frames from AN surgery variy widely. At 30 days post-op, I felt good but was far from 100%.  That can take months.  Finding another job appears to be Adrian's only realistic option.  However, as other posters have mentioned, there are all kinds of state and government programs out there for folks that don't qualify for 'poverty' status but still need some kind of assistance for medical procedures and/or rehab.  I hope Adrian can find some of that help. 

But this is not going to get us down. We will have that surgery on the 6th regardless of this. We will find a way and we will be ok.

I like your attitude Sam.  I believe you two will  be O.K.   You have a lot of people you haven't even met rooting for your 'team'. 

Jim

[robynabc]

As for the youtube video…..I didn’t know what to think.  I was a bit skeptical of the “2 weeks to liveâ€? line, but it keeps ringing in my head.  Also….I was distraught regarding her facial paralysis.  I didn’t think it would be so “dramaticâ€? and I guess the reality of the upward struggle to use one’s face became a reality.  Truthfully, it bummed me out  Not that my attitude has changed, but as I said, the reality of it was scary.

Thank you for all of your posts and support.  You have NO idea (or maybe you do) how good it makes me feel.  It really shows just how good people still can be!



Thank you,
Adrian

Sam,

I just want to cry for what your company is doing to you.  I hate it when insurance in self insured.  All rules go out the window.  They do not have to follow state rules.  I am self employed and I dont' give a damn what a law says,  How do they sleep at night?  I only have a part time employee but I could never ever write a letter like that to an employee of mine. 

You should be able to get cobra for your insurance if you were to be terminated so at least you will be able to keep your insurance.  I hope that is true. 


As far as the video-  Now,  granted I did not see it but two weeks does sound exagerated.  My son, Eric had a 4.5 or more tumor.  It was completely pushing on the brainstem and pushing to like half of what it should be.  The doctor said,  "  We need to get this out", and we heard some worse case stuff. "  And they waited over 6 weeks. They said we had to do it soon but it had been growing there for a long time so we had some time. You just don't want to wait months and months.   I doubt that you are in any really really danger of waiting a little longer. Having a good surgeon is more important than rushing too fast.   Once again your doctors will tell you.  Please know that you are young and healthy and your chances of anything really bad happening are low.  Listen to your doctors they will know.   

This is why I did not watch that stuff before surgery.  I wanted the perfect picture of all the good stories in my head.  I wanted good Karma before the surgery.  I know that sounds silly but it is how I do it. 

I know you will do fine.  By the way,  Sam,  You are so supportive.  You guys are so lucky to have each other. 

I am so sorry that your company is so heartless.

Americas religion-Money.   

Robyn

[Windsong]

Hi,

I am still curious as to how a company for which one works, that owns a medical centre in orlando and is self insured thru fl hospital,  can deny a treatment plan  elsewhere? Is this a conflict of interest?

That  does raise my eyebrows and begs for some answers for anyone else maybe finding themselves in the same situation .....

W.

Thank you all so much for all the advice regarding our insurance issues. Unfortunately Adrian’s insurance is not a group insurance plan. The company he works for owns a medical center in Orlando and they are self insured through Florida Hospital, which is why they want the surgery performed there. The thing though that amazes me is that when we received an insurance quote from Florida Hosp. they quoted $150k vs Tampa General’s cash price of $55k, now even if they get one hell of a discount I can’t see it being a $95k discount!

[Windsong]

I'm always fascinated by how the machinery works down there.

Self insured plans are here too. (either purchased on one's own or a combination of payments monthly by employee plus employer  for some plan the employer offers when one gets hired)...

just about everyone I know who has short term coverage for health situations and then long term situations, pretty much pays a premium every month, every year for that kind of coverage.

I  haven't heard of anyone up here who works for some employer and gets told they can't go for treatment somewhere because the employer owns this  other place they want them to go to?    And then adds oh by the way, you have 30 days to recover from a brain tumour operation or you have to volunteer to resign? Maybe I missed something in what I read. But that's the gist of what I am hearing.

W.

[leapyrtwins]

Windsong -

I don't think you missed anything.  Your summary of the insurance situation, from what I understand, is right on the mark.  Unfortunately, as Brucifer said, Adrian's company can do this.  In my opinion, it's not ethically or morally right, but they can do it.

I'm just hoping that Adrian and Sam can prevail in this bad situation; I think we all are.  Let's keep them in our prayers and hope for the best,

Jan
 

[robynabc]

I am wondering if they used that line "voluntary termination" so they make you feel like you have to resign so they don't have pay unemployment.  I would at the very least tell them they will have to fire you.  My thought is that if a conpany is this heartless they will lie about what you have to do .  I don't see how you have to volunteer to resign.   I wish I knew who these people are.  I understand that you may not be able to say.

Robyn

[Samantha n Adrian]

Trust me Robyn I feel the very same way. I told Adrian even if you are well enough in 30 days to go back I myself would not want to return to them after the way they have been through all of this.

AND...

Wow….. What a rollercoaster ride of a morning.

Update on the insurance issues and coverage.

This weekend Adrian received a call from his case manager regarding the letter forwarded to them from Dr. Bartels stating Adrian’s deteriorating condition and urgency for tumor removal. She sounded distraught and was concerned and wanted to see how he was feeling and said she would immediately forward this to the heads of the insurance company.

Their first question was “Has the surgery date been moved up?�
We explained that it hadn’t and that it was still the earliest date that we could be scheduled. (Just seems like they were missing the whole point of the letter)

So this morning Adrian received a phone call from the insurance department on his way into work. They said that they have a doctor here in Orlando that says he can treat Adrian’s tumor with Radiotherapy and that Adrian had an appointment with him at noon today.

When Adrian called me to tell me this all I could do was laugh! I thought to myself, what kind of grade school doctor are we dealing with here?? That is absolutely above and beyond absurd!

Adrian’s initial reaction was of course that he did not want to see a doctor that could even make a statement like that. But I told him that the insurance department must of informed him wrong and maybe said 4mm instead of 4cm. I told him he needed to go see this doctor that they have recommended and that hopefully it could work to our benefit.  And sure enough it did!!

Upon looking at Adrian’s MRI the doctor said that his tumor was extemely serious and needed to be removed as soon as possible and Radiotherapy was out of the question. He told Adrian that he had no where near the experience that Dr. Van Loveren had in Tampa. Adrian asked him if he could please report this to his insurance company and he said that he would. So I believe that now they truly have no excuse to deny his coverage for Tampa. I feel like this has sealed the deal on proving to them that Tampa is the way to go.

So keep your fingers crossed for us!!!!   

Sam~

[Mary 117]

Sam & Adrian,
Reading your story. Just need to send all sorts of positive thoughts from Montana to you. No one experiences are the same but we all share the worry with you. Stand up for what you know is right and follow what you believe is the best for you and somehow it should all work out.  i was told 4 days before surgery that my insurance wouldn't cover my "out of plan" surgery". Well, we still made it happen and I went back to work 3 1/2 weeks after surgery. I know that we all wish we could take some of the worry away.  Hang in there.

Mary

2cm x 2cm Middle Fossa  HEI Dr Brackmann 5/24/05

[linnilue]

Dear Sam and Adrian,  You see, there really is a God!!  I think that what you two accomplished today was remarkable and thank God (literally and figuratively) for the secretary's mistake on the tumor size!  It's almost like a game isn't it?  Only it's not fun even though you are winning.  And you really are whether you perceive it or not I and I think everyone else sees it.  Every time I read your posts I am very disturbed at the way we are all controlled by insurance and politics in this country.  I thought of both of you all weekend and hoped that you would be able to get to Tampa.  I know the job may have to go but it's their loss for losing such a great, well rounded and educated guy with a girlfriend of the same credentials.  My husband and his partners are always looking for good sales people and they have alot of connections all over including Florida.  So, if after this is all over and you need a job, just send me and email and I will pass it on.  What a shameful bunch you work for.  My fingers are crossed, I hope your answer comes soon this week so that you can spend some quiet time together just to relax and enjoy your time before surgery.  My Best,  Holly