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skeye
Veteran Member


Date Joined Mar 2008
Total Posts : 2976
   Posted 12/28/2009 5:08 PM (GMT -7)   
So as you all know, I was supposed to have surgery tomorrow for a peripheral nerve stimulator trial. Well, I got a call this afternoon from the surgical coordinator. Tomorrow's surgery (and therefore next week's surgery as well) has been canceled. My &$#$&*%#$ insurance company denied the procedure at the very last minute, claiming that the procedure is "experimental" and "it's only facial pain." The surgical coordinator is such a sweetie. You could tell that she was very upset and angry as well (she even had some choice words with the insurance rep in my defense). The appeal process has already begun, but it will take up to 2 days for the insurance to respond to the appeal & they will most likely reject it, so we'll have to appeal again.

I was really really really looking forward to tomorrow & the possibility of relief. I just hope we can get the insurance company to improve the stimulator before I go back to school at the end of January. My sister says that it must just not be meant to be at this time & not to worry too much, but I'm just so upset. I can't seem to see any bright side to this whole mess. I don't know how much longer or how much more or this pain I can take. I wish these @$&$# insurance people could experience the pain that I'm in every minute of every day. I bet they couldn't even make it through a day, let alone 3 years with no relief. I'm just angry and hurt and upset. I really don't need this right now; not when my depression is already out in full.

Hope everyone had a better day that me.

Skeye

Pete trips again!
Veteran Member


Date Joined Nov 2006
Total Posts : 1899
   Posted 12/28/2009 5:58 PM (GMT -7)   
So, So Sorry Skeye! I hate those insurance people! You're right, I wish they all could feel your pain for a while and then see whats denied!!! I am for a loss of words at what else to say lil Sis, but please know that I'm praying that they change their stuoid minds!
Hugs & all my best!
Pissed off Pete

Tirzah
Veteran Member


Date Joined Jul 2008
Total Posts : 2280
   Posted 12/28/2009 6:04 PM (GMT -7)   
Oh Skeye,

I am so sorry. Keep up with the appeals. Usually the third time's the charm. It totally sucks, though, that you have to wait any longer to try a promising new treatment.

I can relate to your sentiment that the insurance people ought to be forced to live in excruciating pain. The nit-wits at my insurance company couldn't understand why I was asking for them to cover enough of my medication to get me through the holidays even though I ran out because they apparently need a full two weeks to prepare any orders labeled "rush shipment". What the heck did I pay all that extra money for? I got my non-controlled meds that I sent regular mail over a week ago, but since I'm not willing to deal with them sending pain meds through the mail without any sort of a tracking number (since one of them was lost a few years ago & we have no idea where), I had to wait longer to get my pain meds. So dumb. And the idiot lady with the insurance just said she didn't understand what the big deal was about going "just 6 days" without my pain medicine or sleeping medicine. Yeah. Brilliant, right?

Good news was that after calling multiple times, having the pharmacist call multiple times & then getting a quick threatening letter from my PM, they finally got their deal together & approved a week's worth of meds.

Wishing you equal success. Hopefully it won't take too long. Just keep reminding yourself that once you find pain relief, the fact that it took an extra week or two will not matter anymore. They have done nerve stimulators for all sorts of head pain, including trigeminal neuralgia (for which I've heard it is actually FDA approved) & that is face pain so it makes no sense that they are trying to deny you. Maybe your doctor needs a new diagnosis code (sometimes there are 4 or 5 diagnostic codes for the same condition/procedure, so maybe that is one way to go. a friend of mine who is a nurse & medical reviewer for an insurance company tipped me off on that one time & it really helped when the insurance refused to cover trigger point injections in my head because they said they were "unproven"). There are all sorts of tricks. As a last resort, if you can find a way to contact someone either at the FDA or with Medicare to find out whether the procedure is covered for treatment of any of the issues you have (even if it's not the primary cause of your pain), you can possibly use that to force your insurance company to cover it. Usually if Medicare covers something, the insurance companies don't want the risk of denying the procedure & will authorize it.

hugs & prayers,
frances

Blessedx8
Veteran Member


Date Joined Aug 2008
Total Posts : 3193
   Posted 12/28/2009 6:09 PM (GMT -7)   
Skeye...

I'm so sorry, honey!! I really am. It's awful to be looking forward to something that may possibly work...and have it canceled at the last minute. I've been there -- and it's depressing, frustrating, etc etc.

I'll keep you in my prayers that the appeal will go through, hopefully this first time...

I'm so sorry, Skeye, for all you are going through... I really am.

Tina
Pain Issues: Cervical/Thoracic back pain; migraines; carpal tunnel syndrome; widespread joint/muscle pain, nerve pain in hands/arms/feet; I also have Dysautonomia/POTS; CFS/Fibromyalgia; Severe Hypertension; Hypothyroidism; Hypoadrenalism; Mixed (Obstructive/Central) Sleep Apnea - on Auto BiPap; Depression/Anxiety; etc etc

Meds: MS Contin; Dilaudid; Actiq; Soma ; Neurontin; Atenolol; Midodrine; Phenergan/Zofran/Reglan; Effexor; Synthroid; Prednisone; and on the list goes...

Future Plans: Intrathecal Pain Pump; already completed trial; awaiting my decision for implantation


Chartreux
Veteran Member


Date Joined Aug 2006
Total Posts : 9622
   Posted 12/28/2009 6:42 PM (GMT -7)   
Skeye,
I'm so very sorry...sure wish you could have this procedure. I would tell you to keep trying but I don't think the Insurance is going to budge from their position..I had a procedure denied as well and it was FDA approved in 2003, it's lousy that Insurance can do this to us, procedures that can help are being denied, over less helpful procedure such as injections..You know I support you in a heartbeat but just don't get too hopeful, Insuance is a big racket..they'll only do things if they can get a profit outta it too...I wish you well in the appeals, I appealed mine for over a year and they still don't approve and I can't afford it...If I could chip in for you, or PALady for help I would, I'm sorry you have to go through this...
Please know you'll be in my Prayers tonight, lots of soft hugz
(((((((((((((((((((((((((((((((((Skeye)))))))))))))))))))))))))))))))))))))))))))))))))))
here's a shoulder for you to cry on, maybe ask if your doctor can re submit it under something else like injections...
**********************************************
* Asthma, Allergies, Osteoarthritis, Spinal Stenosis, Degenative Disc (Lower Lumbar S1-L3 and Cervical C5,C6, C8 and T1), Fibromyalgia, Gerd,
Enlarged Pituitary Gland, Sjogren's, Ocular Migraines, mild carpel tunnel, ect.... "Would be nice if we could use the edit button in real life"...

********>^..^<********>^..^<********>^..^<********


PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 12/28/2009 7:25 PM (GMT -7)   
Skeye,
I hope I can get this post off before I crash! I'm so sorry about the insurance issue!! Frances has a good point about the codes, although I have a hunch the woman at the doctor's office probably already knows this. I got the codes from my GI doc's office about a type of RF ablation they do for the precancerous cells in my esophagus. I called the insurance and so far it appears they'll cover it - but it has to be done in the hospital. However, when I asked what the code was, it technically wasn't for the procedure (called a HALO) but for some more general esophageal surgical procedure, and the doctor does the HALO while he's doing that. They don't technically biil for the HALO. However, with the stim unit I think that would be tough to do.

Don't give up hope. If necessary, maybe you'll need to contact an attorney. See if the docs who have done the procedure before (wherever they may be located) can give you more info. If you can show that insurance has paid for other people to have it, that could strengthen your case.

I'll be thinking of you!

Hugs,

PaLady

Screaming Eagle
Forum Moderator


Date Joined Sep 2009
Total Posts : 5005
   Posted 12/28/2009 7:28 PM (GMT -7)   
Skeye, I too am right there with the rest of the members here on this. I'm so sorry to hear this, as it was some hope for you. Pain is not a friend to anyone here, and we all sympathize with you. I certainly hope the appeals process will get the ball rolling in your favor again. It is beyond my understanding why they would do this, instead of opting to care for you're condition for the rest of you're life. Did they agree to it at one time already prior to your surgery date? if so, I would think you might have a valid reason for some sort of legal option. We all support you, and will be thinking about you as well through this tough time. Take care my friend, and well wishes to you in the deepest sincerity I can offer.


You're Buddy,
Michael

It's good to see most of the old crew here again, doing our thing,
for our wonderful members! Thank you to all of you, for supporting Skeye.
She has been there so many times for all of us, it is only fitting, that
we return the favor to her. What a wonderful place for support!
We are all family here, and I encourage any visitors to join us!
You will never regret it! yeah

Post Edited (Screaming Eagle) : 12/29/2009 10:34:23 AM (GMT-7)


mrsm123
Veteran Member


Date Joined Dec 2007
Total Posts : 1228
   Posted 12/28/2009 7:38 PM (GMT -7)   
Skeye sweetie,
I am so sorry to hear this, but I am not going to tell you to give up, instead see what you can find about your condition and it's treatment online. Go to the FDA website and check there too. What you want to find are any supporting studies about nerve stimulation and your condition. Go to Google and type them both in , separated by a comma or add a plus sign and see what you come up with. You may have to do some reading but if you can locate supporting documentation for it, by all means appeal, a ppeal and appeal again........call your surgeon and tell him to write a letter to the insurance company in support of the procedure and why.....
Sandi
PLIF/TLIF Fusion w/Instrumentation L4-5 Spondololysthesis L4-5.Laminectomies L4-5, foraminal stenosis L3-4, L4-5, L5-S1, herniations L3-4, L4-5, L5-S1, central canal stenosis L3-4, L4-5 and L5-S1
POST OP CES 3/30-06
Neurogenic Bladder and Bowel, bilateral numbness legs and feet
Revision for failed Back surgery, pseudoarthrosis L4-5, hemilaminectomies L3-4, L4-5, L5-S1, bmp added to revision fusion, replaced two bent screws that were reversing out of vertebrae - August 2, 2007
On going back pain and neuropathic pain, failed back surgery, consult for scs, decided not to do that at this point.
Adhesive Arachnoiditis also......just what I didn't need..9/08- adding bilateral ulnar neuropathy with severe compression to the mix. They want me to see a surgeon for ulnar nerve surgery, but I'm not biting.
I've seen enough surgeons over the last few years.
Avascular necrosis of left wrist- maybe hips too


bluejet2
Regular Member


Date Joined Feb 2009
Total Posts : 487
   Posted 12/28/2009 10:07 PM (GMT -7)   
Hi Skeye:

I am so sorry for this setback, but you can't give up! They are using these stimulators for so many different conditions, and insurance companies are paying for it, I have to believe they will approve it for this as well!

You will be in my thoughts and prayers!

Lorie

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 13455
   Posted 12/28/2009 10:32 PM (GMT -7)   
Oh Skeye, I am so very sorry that this has happened to you. But, don't you give up on this, fight them tooth & nail. Please keep us updated on what happens. Hugs,
 

crohns disease dx 2002 & small bowel resection, still looking for remission whatever that is, chronic pain 22 yrs, added ulcerative colitis 6-05 to the mix, high blood pressure 28 yrs, aortic heart valve insuffiency, depression, osteoarthritis, osteoporosis lumbar spine, scoliosis lumbar spine, peripheral neuropathy hands & feet, COPD & on oxygen therapy, lupus & psoriasis and psoratic arthritis. Several other health issues just not enough room to list it all. Too many surgeries to list and too many medications to list. Currently on 17 different daily medications. Intrathecal pain pump implanted June 05.


White Beard
Forum Moderator


Date Joined Feb 2009
Total Posts : 3610
   Posted 12/28/2009 11:32 PM (GMT -7)   
Skeye

I can only imagine the frustration that you must feel! Honestly I feel it too ( for you) Hang in there I honestly believe that this was meant to be it is just that the insurance company needs to know that! And I believe they will, it just might take some convincing that is all! Hang in there! We are all behind you giving you support!

Keep the Faith! Wishing You all the BEST!

White Beard

edt
Veteran Member


Date Joined Dec 2008
Total Posts : 773
   Posted 12/29/2009 6:17 AM (GMT -7)   

(((((((((((((((((((((SKEYE))))))))))))))))))))))))))

XXOO
Patti


Amaristo
Regular Member


Date Joined Dec 2009
Total Posts : 29
   Posted 12/29/2009 8:40 AM (GMT -7)   
I really really hope this works out for you. God I hate insurance companies. HATE them. ugh.

I'm so sorry.

skeye
Veteran Member


Date Joined Mar 2008
Total Posts : 2976
   Posted 12/29/2009 10:40 AM (GMT -7)   
Everyone,

Thank you so so much for all of the support and advice!! It means so much to me! I had a really really rotten night last night. I was in so much pain & I was so upset (and of course each makes the other worse). It was so nice to fire up the computer this morning & see all of your kind responses!

Let me clarify a little. The surgeon has already faxed the insurance company all of my records and a bunch of research supporting the use of the device. He also personally called them yesterday, but unfortunately didn't reach a live person, so he'll call again today. If necessary, I'll get my other doctors involved. I've already spoken to my pcp & he was angry as hell & offered to help in any way possible. The good thing about all this is apparently the surgeon's office had a patient several months ago with the same insurance from the same state & their stimulator got denied too. However, after several appeal processes the insurance finally did approve it. So hopefully they'll end up approving mine in the end. I'm trying to stay positive, but it's hard. I just want to go through with this so badly! Pray for good news from the surgeon's office this afternoon! I'm just fortunate that I have so many wonderful people fighting for me!

Again, I can't thank you all enough for your support! Each and everyone one of you are very dear to me.

hugs,
Skeye

Chartreux
Veteran Member


Date Joined Aug 2006
Total Posts : 9622
   Posted 12/29/2009 10:43 AM (GMT -7)   
Prayer's that you'll have it done before the new year...
hugz
finger crossed this time...
**********************************************
* Asthma, Allergies, Osteoarthritis, Spinal Stenosis, Degenative Disc (Lower Lumbar S1-L3 and Cervical C5,C6, C8 and T1), Fibromyalgia, Gerd,
Enlarged Pituitary Gland, Sjogren's, Ocular Migraines, mild carpel tunnel, ect.... "Would be nice if we could use the edit button in real life"...

********>^..^<********>^..^<********>^..^<********


PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 12/30/2009 12:17 AM (GMT -7)   
Skeye,
If the appeals finally worked for that other patient, that is a good sign. The ins. company is probably trying to fight paying for it to set precedents. See if you can find other insurance companies that are paying for it. The more support you have that this is a covered procedure - or becoming one - the more solid footing you have, although I wouldn't be surprised if it took a few tries. So don't get disheartened if it doesn't come through right away.

Good luck!!!

Hugs,

PaLady

fatherjohn
Veteran Member


Date Joined Feb 2009
Total Posts : 999
   Posted 12/30/2009 2:58 AM (GMT -7)   
Skeye, I have an idea, I will fly out there, pick up Pete and Whitebeard and we will go make a personal visit to the insurance comnpany. With Pete's Italian connection we can say we are from the "family". I can still swing a mean cane. Whitebeard will be the hole card. They will think that we recruited Santa and won't want to start off on the naughty list. Just wanted to put the option out there. It is 2 am and creative writing is helping to pass the time. But we are family!

Pete trips again!
Veteran Member


Date Joined Nov 2006
Total Posts : 1899
   Posted 12/30/2009 5:23 AM (GMT -7)   
Sounds like a plan FJ! We'll make dem an offer day can't refuse! With my extra Christmas weight I can cast a large shadow on the powers that be! I can always drop a dime to da family back in Joisey, if yuze know what I'm talkin about? Uncle Falluch has been board lately anyway!

But honestly, Skeye, we're all pullin & prayin for you!!! I know you must be very tired of hearing "No" from those insurance jerks but from what you said about the other person finally getting the procedure after apeals, it sounds like you have a great chance!

Hang in there Lil Sis, better days are comin! Just keep telling yourself that!!! Anytime you find your bottom dragging and the blues are setting in, fire up your old puter and punch up HWCP, your friends and family will be here for you!!! Datz a promiss!!!
Mucho Hugz from Big Bro>>>
>>Pete

skeye
Veteran Member


Date Joined Mar 2008
Total Posts : 2976
   Posted 12/30/2009 8:11 AM (GMT -7)   
Fatherjohn,

I absolutely LOVE your idea!! Sounds like fun! When can you come?! smilewinkgrin

The insurance denied the first appeal. Apparently they cut my doc off mid-sentence and yelled "no" and slammed the phone down. Isn't that nice? The second appeal will be started today. When I talked to the surgical coordinator yesterday, she said that the other patient got the procedure approved after the second appeal, so that's what I'm hoping for! The second appeal involves a review of the case by an independent source. Hopefully they'll be more understanding! Like Palady said, I'm taking it to be a good sign that the other patient eventually got her implant approved.

Skeye

Amaristo
Regular Member


Date Joined Dec 2009
Total Posts : 29
   Posted 12/30/2009 8:29 AM (GMT -7)   
Wow. I don't understand how companies can even get away with treating doctors and patients like that. Did they ever hear of customer service? Why yell at a doctor? Why not just calmly say no. I guess they can do almost anything they want since they have a virtual monopoly and there are so few options out there.

Bad communication and poor customer service is such a pet peeve of mine. Treat people with respect and maybe you won't be hated.
Diabetes: 25 units of Lantus insulin, 1500mg of metformin
Neuropathy: 300mg of Lyrica, 100mg of Tramadol 3x a day, Norco 30mg 3x a day, or as needed for the pain.
Supraventricular Tachycardia (SVT) and Arrhythmia: 50mg of Metoprolol 2x a day.
Irritable Bowel Syndrome (IBS): Lomotil and Promethazine as needed.
High Blood pressure: Metoprolol and 100mg of Cozaar
High Cholesterol: 40mg of Pravachol


privey
Regular Member


Date Joined Oct 2009
Total Posts : 453
   Posted 12/30/2009 1:40 PM (GMT -7)   
Skeye
I feel so discouraged for you I know how much you were hanging on to that thread of hope. Keep appealing and I'll keep you in my thoughts and prayers and maybe with all of us chugging together we'll make something good happen for you.

tmjpain
Veteran Member


Date Joined Oct 2008
Total Posts : 2022
   Posted 12/30/2009 2:23 PM (GMT -7)   
OOHHH I am so sorry for this delay Skeye! I hope things turn out for the best. it seems to be a very difficult process in the states. I am trying to find out if this procedure is even done in Ontario and who does hospital admissions to do 1V medication administration to break the pain cycle.
 
Thinking of you, and wishing you quick answers to the problem!!
 
Hugs
Suzane

Chartreux
Veteran Member


Date Joined Aug 2006
Total Posts : 9622
   Posted 12/30/2009 4:14 PM (GMT -7)   
I like FatherJohns plans, so if you need the help, go for it...
soft hugz...
(((((((((((((((((((((((((((((Skeye)))))))))))))))))))))))))))))))))))))))))))))))))
**********************************************
* Asthma, Allergies, Osteoarthritis, Spinal Stenosis, Degenative Disc (Lower Lumbar S1-L3 and Cervical C5,C6, C8 and T1), Fibromyalgia, Gerd,
Enlarged Pituitary Gland, Sjogren's, Ocular Migraines, mild carpel tunnel, ect.... "Would be nice if we could use the edit button in real life"...

********>^..^<********>^..^<********>^..^<********


catahoula
Regular Member


Date Joined Dec 2009
Total Posts : 184
   Posted 12/30/2009 5:38 PM (GMT -7)   
ditto ditto ditto.Skeye. I am sooooooooo sorry about your surgery being cancelled and at the last minute. I agree with all that was said. Fight it. Medicare will pay for it. They paid for my second opcippital trial stim. That should give some leverage  to your insurance.
I'm keeping all my fingers and toes crossed for you. If you ever want to talk about the implant WHICH YOU WILL GET just give a yell.
only good thoughts coming your way
cat 

Stella Marie
Veteran Member


Date Joined May 2005
Total Posts : 601
   Posted 12/31/2009 2:01 AM (GMT -7)   
I am so sorry Skeye. My insurance company also denied my SCS three times, It was not until I went on disability and was forced to switch to Medicare did I receive and OK to go, Medicare approved the request the first time. I am not sure whether my orginal insurnace company denied me because they knew I would be switching to Medicare within 7 months or not, Are you by any chance in the process of changing insurance companies? Could this company be trying to dump the 60,000 + cost onto a future insurance company or medicare?

Stella Marie

Moderator for Chronic Pain and Epilepsy

Rare neurodegenerative /movement disorder called “Multiple System Atrophy”.  Mobility issues,, neuropathic pain,  spasticity, myoclonus, central apnea, collagenous colitis, joint and body pain, swallowing and respitory  involvement,  Implants: intrathecal pump & neurostimulator.  Extra features: O2 & wheelchair.

 

 

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