Insurance wont pay need some help!!! Anyone!!!!!!!!!!

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helpmycoworker
New Member


Date Joined May 2005
Total Posts : 1
   Posted 5/19/2005 10:30 AM (GMT -7)   
Hi!  I'm new to this site.  My name is Kim and I am from Ohio, I am not an arthritis sufferer but I have a very close co-worker that is.  He is 30 years old and takes Remicade treatments every 6 weeks through IV.  I am searching for some help.  The insurance company sent him a letter and stated that they would pay for this treatment at 100% and he received 2 treatments.  The insurance company then stated that they made a mistake and would only pay 80%.  he is left owing around $1100 for these treatments and can not get another until this amount is paid for.  He has convinced the insurance company that they should pay for this at 100% for the future treatments but they will not go back and pay the other 2.  I am searching for any foundation, organization or group that he may be able to speak with that could assist him in paying this bill so that he may be able to continue with this much needed treatment as soon as possible.  It has been almost 8 weeks since his last treatment.  Just so you know he is a very hard worker and is a great provider for his wife and 1 year old daughter.  He could use a little help!  If anyone has any ideals or avenues we should try please let me know!!  Thank you soo much and God Bless you all!! 

erin.K
Veteran Member


Date Joined Mar 2005
Total Posts : 3148
   Posted 5/19/2005 7:44 PM (GMT -7)   
yikes, can you appeal the insurance? if it is in writing that it is to be covered....they cannot take that word back and say.."oh, i made a mistake". some of the administration on a psych floor were discussing a topic like this a few weeks back. they had given a name of a physician covered under a patience insurance, the pt got a referral, was approved....a few weeks later the ins co. said "oops we made a mistake, doc is out of state so it's not in our plan". it came down to that legally, since it was pre approved and IN WRITING! the ins co HAD TO PAY WHAT THEY SAID THEY WOULD! yea!
i hope that story offers some Hope!
he needs those treatments! what about a loan? or a small payment installation?
i go through the same thing all the time...i just let the bills pile up! i'm so much in med debt.
if worse comes to worse and he needs this Tx desperately; perhaps there is a small personal loan available?
best wishes
erin

straydog
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Date Joined Feb 2003
Total Posts : 13466
   Posted 5/19/2005 8:11 PM (GMT -7)   
I think your co-worker needs to consult with an atty on this matter. Susie


oreo
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Date Joined Feb 2004
Total Posts : 528
   Posted 5/25/2005 6:29 AM (GMT -7)   
Insurance Co are such finicky groups. Out for the bottom line and often the patient is the one stuck in the middle. I realize it is a business but when it is your health on the line you kind of resent that. Have your frien look into legal help. The Ins. Co have more money then him so this could become a war of money. He needs good legal help and a lot of emotional support. Gather his friends and co-workers around and let him know that you are with him on this. Maybe not financially but emotionally. This will be hard on him and his family and it helps to know that he is not alone.
My prayers are with him and his family.
Oreo
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Keah
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Date Joined Nov 2003
Total Posts : 7314
   Posted 6/10/2005 10:59 AM (GMT -7)   
Call your State Deptartment of Helth. They should be able to direct you to the proper Agency to file a complaint. He should be able to get some assistance thorugh the local goverment agencies that regulate the insurance carriers in your state. As long as he has the letter that they wrote, it should be reimbursed. Our local news broadcasts also have consumer advocates. Do yours? Call one of them for assistance if you can't get help through the State Agnecies.

Good luck.
Keah a.k.a. Wormy
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Chutz
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Date Joined Jan 2005
Total Posts : 9090
   Posted 6/10/2005 11:24 AM (GMT -7)   
You might also try your local state representative. A call to their office often gets things moving when time is critical.

Chutz
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curley
Veteran Member


Date Joined Mar 2005
Total Posts : 4305
   Posted 6/12/2005 8:03 AM (GMT -7)   
I and Welcome,

I have crohns,ra,oa,and I use to take Remicade and before I had my first one the insurance had approved it and when we got there they told us that the insurance came back and said they would not pay for it.My ex-husband got on the phone and told them that if they did not do what they said and pay and approve my treatment that he would fiel a complaint with the insurance board.Needles to say they called the hospital and approved my Remicade treatment after that we had know moore probles.

If that does not work you may want to consider calling your local state representative like Chutz said.They can help that is what they are there for and like susie said you may want to contact a lawyer that specializs in that field.

I wish him much luck and he is very lucky to have a friend like you that cares enough to try and help him.

Let us know how it goes.

Curley......
a.k.a.Mela.....

CaMama
Veteran Member


Date Joined Mar 2005
Total Posts : 1884
   Posted 6/12/2005 8:29 AM (GMT -7)   
Ask your doctor, there is a foundation out there (I think set up by the company that makes Remicade, I'm not sure) that you can apply for help with. They will subsidize and help pay for treatments if you qualify. My brother in law looked in to it, but I off-hand do not know the name.
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