A special thanks goes out to Congressman John Sarbanes and Lisa Dailey for their assistance in helping me resolve this matter. You both are giving great service to your constituents and you have earned my vote from here on out.

Thanks,
Adam

On Sunday, December 20th, 2009 I was taken to Harbor Hospital, in Baltimore, MD, by my dear neighbor Maggie and was diagnosed with Type 1 Diabetes, something that I will treat for the rest of my life with constant blood sugar testing and daily insulin injections. For months I had been experiencing a gradual increase of symptoms beginning with a lack of energy and growing into an insatiable thirst, an inability to sleep, loss of vision, irritability, and weight loss. It all came crashing down on Friday, December 18th, 2009 when I got home from work and, despite hosting a holiday party at my house, went straight to bed with what I thought was flu-like symptoms. Oh boy was I wrong. I spent all weekend fading in and out of consciousness while only waking to vomit the water I couldn’t hold down. On Sunday morning I managed to get out of bed to try to get a glass of water and felt extremely incoherent, dizzy, and I was hyperventilating. I ended up falling halfway down the stairs and managed to crawl to the sofa. It was then that I realized that this was no flu and that I should seek medical attention. I tried to call my roommate Mike but, he was halfway across Maryland at the time. Luckily my neighbor was home and she was able to rush me to the hospital. By the time I arrived at the emergency room I was barely able to tell them my name as they rushed me back into the ER. After a series of blood tests and 5 iv drips I was given my diagnosis, Diabetic Ketoacidosis(DKA) arising from undiagnosed Type 1 Diabetes, severe vitamin deficiency, and dehydration. Surprisingly, my initial reaction was relief, at least I now know what was making me ill, I mean I’ve never felt so bad in my life and I really thought I was going to die. After my condition started to become stabilized I was informed that with a blood sugar of 737 and the severity of my symptoms I could have slipped into a coma within 8-12 hours had I not gotten to the hospital, and had that happened death would have followed shortly there after. I want to personally thank Maggie, Mike, and my Parents who stayed with me while I was in the ER, their support during a trying time will never be forgotten.

A period of self analysis and reflection followed as I was transported to the Intensive Care Unit. I spent the next day alone asking myself a series of questions to which I had no answers. What is Type 1 Diabetes, I mean I have heard of it but what is it exactly? What did I do to deserve this? Could it have been prevented? How will I deal with it? How much will my life have to change to successfully manage this disease? How serious is it and is there any hope for a cure? Will I really be able to give myself injections everyday? What I did not ask myself was how will I pay for this, after all I have a good PPO policy with Blue Cross Blue Shield through my employer. I work at NASA so surely my benefits package has to be pretty good right? Wrong… more on this later…

Upon being transferred out of the ICU and into a normal room my blood sugars had dropped to the high 200′s and I was beginning to regain a little energy. For the next day I had a number of visitors, my parents of course were there, and Mike also came back to visit with another friend Matt. I received phone calls from a few work friends and my boss even sent me flowers. I was also visited by a number of doctors, nurses, and Diabetes educators who answered a few of my questions about the disease and helped me understand the steps I need to take to manage it. This is when the weight of it all finally started to hit me. I was thinking clearly again and I tried to comprehend the 180 my life just took.

A day and a half after being released from the hospital, Christmas with the family provided me with a welcome escape from my stresses. Although I was a bit distracted and stuck in thought most of the next week I did enjoy the holidays despite my outward appearance. I did not tell many people about my health initially as I had a fear of being judged or looked at differently, although I’m sure many found out through the grapevine anyway.

Over the next few weeks I visited with my Endocrinologist, Dr. Elizabeth Briggs, who helped me self manage my blood glucose levels with the help of two types of insulin and a new diet which limits the amount of carbohydrates I ingest. My vision returned to normal after about 4 weeks and I slowly started to get back into the flow of my pre-diabetic life. Mentally however, I was still not there. I went into a period of being depressed and being anti-social as I coped with the lifestyle changes. After a month or so those feelings faded and writing this blog is the culmination of me coming to grips with the disease and feeling comfortable enough to share my story with the world.

Now is were the real problems begin…

About mid February I receive a letter from Blue Cross Blue Shield of Alabama, that is where my company is headquartered, saying that my benefits had been denied. Shortly thereafter I get the processed claim report showing all the Hospital’s expenses and the amounts to be paid by me. The largest bill was for ~$5300 in addition to a number of smaller bills, all of which total to well over $6000. Now I am no rich man and $6000 is a pretty penny, especially when it’s $6000 I shouldn’t have to pay. I made a few calls to Blue Cross and to the Hospital to try and figure out why I wasn’t being covered and after getting the run around, being told it was being taken care of only to later find out it had not, determined it was because pre-admission certification was not timely obtained, which in the case of emergencies must be obtained within 48 hours. Now 48 hours has obviously passed by the time I learned this, hell 48 hours passed before I was released from the hospital. Someone please tell me how is it feasible for me to get pre-admission certification while I’m recovering in a hospital bed. And how is it not the hospitals responsibility to get all that info to the insurance company. So what, now all patients, regardless of their condition, have to get pre-admission certification before being admitted/treated?!? Great while I wait for that I’ll just go over to the corner of the waiting room and die thank you very much.

Since then, I have learned that Harbor Hospital has appealed my case to Blue Cross to which Blue Cross promptly refused coverage again, sticking to the contractual language that in the case of emergencies pre-admission certification must be obtained within 48 hours.

My issues arise out of the fact that I pay for insurance coverage every month and in my time of need they throw me to the curb over an arbitrary and unreasonable time limit. I did not ask for Diabetes and my visit to the hospital was certainly out of necessity and not choice so how is it fair for my insurance provider to abandon me, isn’t my diagnosis punishment enough?

I have 180 days from the initial denial to appeal my case which I have already done after consulting with a lawyer. However, I am not optimistic about my own appeal after learning that they already denied an appeal by the hospital. They have my medical records so what more can I say that the Hospital has not already said.

My next steps are as follows: 1.) Contact my employers HR department and legal team to attack this from their end, 2.) call my local congressman and senator to see if I can gather some steam behind this case, and 3.) hire a lawyer with jurisdiction in the State of Alabama to bring suit against the insurance company. I will keep updating this blog post as this progresses so check back in the coming weeks.

I want to gather as much awareness as possible to my situation with two main goals in mind, 1). to help my own cause and get this issue of denied coverage resolved and 2.) to help others in similar situations by giving them the knowledge that they are not alone and that through due diligence things like this can be resolved in a favorable manner.

Wish me luck and thank you for taking the time to read my story!

Michael Phelps on the Awards Stand after the 400 IM Final