Health insurance

D

DeerMadness

Long Time Member
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So I've been given the runaround and denials etc etc for a neck surgery as I have bone on bone and its affecting strength in my arms and causing tingling and numbness in my hands. Has anyone had to fight and then prevailed in a battle with bad faith situations ?
Advice will be listened to.
Thanks
 
Dunno about the bad faith stuff....

But, I had my neck fused before the numbness/tingling arrived and after the bone/bone thingy. Lotsa bad things happen with respect to vibrating things (helicopters) and soft tissue (disc stuff).



?Nothing in this world can take the place of persistence. Talent will not; nothing is more common than unsuccessful people with talent. Genius will not; unrewarded genius is almost a proverb. Education will not; the world is full of educated derelicts. Persistence and determination alone are omnipotent. "
 
No Helicopter rides I'm not that lucky. I had 5,6,7 done 1q years ago no hassle. Most of the damage is from a severe crash at the St Anthony Sand Dunes. I flipped about 6 or 8 times and the 700 Raptor flipped even more. How I didnt get paralyzed I have no idea but lucky. The sun washed out the humps and I hit one at 40 mph.
I have a Brute Force 650 and a Kawasaki King Quad 500 now. I only ride trails for fun or to go fishing and don't use them for hunting. Much more careful too but the damage is already done. Anyone who rides ATVs better take care I've seen much worse than what happened to me.
One guy lost his home, wife and everything else as he went from Oxyconton to Heroin managing pain then addiction. That was in Utah. I also have an ex in-law who had their daughter burned badly and she died from it. She was on a rented Razor.
 
I had neck surgery about a year and a half ago. In my case, it took my Neurologist and my Orthopedic surgeon to convince my insurance company that it was needed.
My son's father-in-law needed extensive back surgery a few years back. His insurance company would not budge. He ended up getting an attorney involved, which lead to the insurance company to pay up.
 
The medical professionals will need to talk to the insurance provider. Usually, they can convince a reputable company.
 
Dr and you are going to have to be persistent. Also you may look into supplemental insurance? I was actually double covered through aflac and family heritage when I broke both legs on a dirt bike. Aflac paid about $800 for it all vs family heritage paying me almost 18 grand. I know it's not health insurance but it might be a possibility to help cover bills.

4b1db2ac644136c4.jpg
 
Yes that would help. I paid 3800 out of pocket so it would have been 100% coverage. If it happens next year my OOP is even higher. What a joke I pay 360.00 a month also just for the medical joke plan.
I'm sure I'm not the Lone Ranger here, I wanted to see how others are doing and if anyone had to fight this hard.
 
mmwb is correct in that your medical provider has to communicate your situation to the insurance company.

Things you could do:

1) Contact your insurance company to find out why they wouldn't approve it. A registered letter would be better than a phone call. If they don't respond, a letter from an attorney would be even better. (An attorney may write you a letter for a couple hundred dollars)

2) Talk to your physician about resubmitting the request. Were all the i's dotted and t's crossed. Did he fully communicate to them why this procedure is necessary and it is an accepted procedure.

3) Get a second opinion on whether you should have this procedure. Maybe it isn't an accepted procedure.
 
If your employer is who you get insurance through, maybe they can help you..??
My wife had that bad ATV wreck in May and had to be life flown to emergency. The insurance company has been a serious pain with regard to that. They don't want to cover the helicopter ride or a few other things.
My wife has also been battling with them over daughters counceling.
Simply a pain dealing with insurance company?s sometimes. The insurance (different company) was great to work with while my first wife battled cancer. When she was diagnosed, I was certain I'd end up bankrupt, but they covered everything with few issues. That was real nice not having to fight with them over everything for 3 years.


Brian Latturner
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REALLY long story short...

I had the pleasure of wasting countless hours over the course of a year listening to my insurance company's emergency dept argue with their preapproval dept and the life flight company for hours at a time over my 20 month old daughter being flown in a fixed wing instead of rotary. She was flown fixed wing because of weather conditions and availability. The 40k claim was eventually denied saying that fixed wing requires preapproval. Wtf? Who even knows or thinks about that crap in an emergency? Dr says fly her, you fly her...

Anyway, yeah insurance is a mess and I have about as good as you can get...

Good luck in your efforts! Hope all turns out well.
 
yeah I have argued with the insurance company for two years on Rapatha which is a cholesterol reducing drug that I need because I have a negative reaction to the regular cholesterol drugs..,

Took two years and my doctor never gave up in trying. The last letter sent to the company, he said if I don't get these drugs I will die and when I do he will give my wife the letter saying they are responsible for my demise.

That letter did the trick they just approved it so don't give up just keep trying until they listen.
 
Most States have a Commissioner of Insurance to help out the 'littleguy', meaning the guy without a dozen attorney's on staff.

If your health insurance company is being unresponsive to you, just mention that you really don't want to go to the Commissioner, but you will if necessary.

The Commissioner is free, so save the attorney as a last resort.
 
I will try that too. One thing is that is an ERISA plan ( Group Health). That makes it tough. I cant believe when you work your entire life never taking Unemployment check, food stamps or welfare and you pay your premiums and expensive out of pocket money then get denials for a serious life changing condition. Meanwhile the Govt has been bending over backward to help lazy people get all kinds of programs for help.
Murica !
 
I am planning to have c3-c6 fused early next year but I haven't done the pre-approval yet. I'm hoping there are no insurance issues. On a related note, is the surgery usually helpful?
 
>I will try that too. One
>thing is that is an
>ERISA plan ( Group Health).
>That makes it tough. I
>cant believe when you work
>your entire life never taking
>Unemployment check, food stamps or
>welfare and you pay your
>premiums and expensive out of
>pocket money then get denials
>for a serious life changing
>condition. Meanwhile the Govt has
>been bending over backward to
>help lazy people get all
>kinds of programs for help.
>
>Murica !


I totally agree with this statement, well said.
 
I had a pain level of 4 or 5 constant in 2006 after a Sand dunes atv multiple flip. About 1 year after accident I had a c5,c6,c7 laminectomy. It was dramatically better and I went down to mostly a mild pain and much of the time pain free.
The problem with that is it stresses the rest, and usually causes future failures in the adjacent vertebrae/disks.
I've has pain for 2 years or so now getting progressively worse i.e. headache,neck pain, hands numb and tingling and some loss of strength.
Ive never sought pain meds and relief only on Aleve and Ibuprofen. That doesn't help much now so surgery is the only option .
I guess some people dont get relief but usually its successful.
Good luck 3point !
 
Thanks DM, I've experienced all those symptoms plus not getting any sleep so it's time to do it. I'm also avoiding opioids so the pain relief isn't what it could be.
 
LAST EDITED ON Nov-30-18 AT 09:59AM (MST)[p]Tell insurance your going to make this a mental case. That your getting depressed with everything from the pain to insurance treating ya like crap. that this will involve counseling/treatment/meds , they don't like hearing that cause its more money they have to pay up on.

Also make a demand that a second/third party looks at the case. if still a know tell your insurance that your filing with the board.


I did all these steps above and just like my they paid up...
 
Update- Insurance says Dr didnt send in the full amount of required treatments I finished at PT . Either the Insurance or Dr are lying. I think I will prevail and get it approved but still waiting on 3rd review...
 
>I am planning to have c3-c6
>fused early next year but
>I haven't done the pre-approval
>yet. I'm hoping there are
>no insurance issues. On a
>related note, is the surgery
>usually helpful?


I had the C-3, C-4, and C5 fused a year and a half ago and the results have been excellent. My surgeon had done 2 previous back surgeries on me and said the neck procedure was much easier to do and a quicker recovery period.
 
Good News ! They called today and said it is approved but cant stay overnight in hospital. So if you dont see me post in 2019 I had a blood clot !
All my stress just disappeared better than having sex , lol.
Moral of my story - you gotta fight for your rights. I called them before they called me and I asked for the names and certifications of everyone on the review board- just a other tidbit that my neighbor shared with me Saturday...??????
 
Good to hear.


About that blood clot...dibs on your guns.



?Nothing in this world can take the place of persistence. Talent will not; nothing is more common than unsuccessful people with talent. Genius will not; unrewarded genius is almost a proverb. Education will not; the world is full of educated derelicts. Persistence and determination alone are omnipotent. "
 
Surgery is scheduled Dec 18. I wont be making Prime Rib or being Santa but I will be on the journey to recovery. I am grateful. If anyone ever needs help with insurance please pm and I will do all I can.
Steve
 
Sure makes me extra grateful I work for a company that pays my insurance 100% and also gives me an HSA account that covers deductibles.
 
Last year I had a 6 figure income but paid over 10k for prescriptions, medical, dental, life insurance and vision which includes my paycheck deductions.
You are lucky Slamdunk.
 
>Last year I had a 6
>figure income but paid over
>10k for prescriptions, medical, dental,
>life insurance and vision which
>includes my paycheck deductions.
>You are lucky Slamdunk.

Heck, if I figure in what all that costs my employer, I'm very close to a 6 figure income ?
 

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