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Scarred_for_life
Veteran Member


Date Joined Jul 2008
Total Posts : 1559
   Posted 2/25/2010 7:01 AM (GMT -7)   
Did you say that you are fighting to get the SCS placed?  Is it your ins that is fighting you?  If so I have a few questions about getting things started with an attorney and the appeal process.
 
Hugssss
 
 
Scarred
I live to "Tame My Pain!" 


skeye
Veteran Member


Date Joined Mar 2008
Total Posts : 2976
   Posted 2/25/2010 10:12 AM (GMT -7)   
Hi Scarred,

Yup, I've been fighting my insurance company for a neurostimulator since the end of Decemeber. They were so kinda as to deny coverage the evening before I was supposed to start the trial. They claim that it is experimental (it's the same device as an SCS, but they'd be placing the electrodes on my trigeminal nerve in my face). My appeal has already been denied once. I'm currently waiting to hear back regarding the second appeal. I should know sometime in the next week. If they deny my appeal again, then I'll be taking my claim to the state insurance commissioner. I'm NOT giving this up!

I'm not sure how much I can help you, since I think that the appeal process probably varies depending on the insurance company, but I can try. I also didn't use an attorney. I filed the appeal myself with the help of my neurosurgeon's office. However, I did contact my insurance rep for advice.

Good luck! There is nothing more frustrating than this whole appeal process!!

hugs,
Skeye

Scarred_for_life
Veteran Member


Date Joined Jul 2008
Total Posts : 1559
   Posted 2/26/2010 8:46 PM (GMT -7)   
Oh that's right it's being placed in your face right? I am not looking forward to my next step which is dealing with a denial from Worker's Comp. But I have both my doctor and my pain psychologist on my side so maybe just maybe it won't be so bad.

So is your doctor still caring for you? I the ins still paying for meds, tests, etc?

I think this whole thing is redicilous and I am not looking forward to having WC crawl down my throat.

hugssss\\Scarred
I live to "Tame My Pain!" 


skeye
Veteran Member


Date Joined Mar 2008
Total Posts : 2976
   Posted 2/26/2010 9:06 PM (GMT -7)   
Scarred,

Yup, the stimulator would go on the trigeminal nerve in my face. Unfortunately I just got the second-level appeal denial letter in the mail today. Now the next step for me is to go to the State Insurance Commissioner, unless the insurance company screwed me over (see my current thread), in which case I may need to get a lawyer.

The doctor who would implant the stimulator is a neurosurgeon. I've only seen him once - for a second opinion/evaluation for a stimulator, but he has been great & is willing to fight for me every step of the way. He spent months doing his own research on my case after meeting me, so he didn't his recommendation for a stimulator lightly to begin with. Other than that, I my regular team of doctors (pcp, neurologist, ophthalmologist, and neuro-ophthalmologist) are all still caring for me & they all highly support my decision to go ahead with the trial. They all wrote letters of appeal to my insurance company when I got denied. Other than the stimulator, I haven't ever had any problems with my insurance company. They just paid for another MRI a few weeks ago (which frankly shocked me). It is so ridiculous because they will probably end up spending more on me in the long run if they don't approve the stimulator trial, than if they did & the stimulator worked.

You're absolutely right, this whole thing is ridiculous! It is all about the money. They don't care about the people at all. The insurance companies couldn't care less whether you are in so much pain that you literally barely make it through every day, all they care about is how much is coming out of their pocket. I hope you have better luck with your insurance than I did with mine. The main reason that they denied mine is because it is "experimental." In a sense that is true, because my case is pretty unique, but I found a lot of good published data to support my case, and furthermore the insurance company states that they have the "sole digression" to decide what is experimental and what is not -- so in other words "what they say is always right & no one can argue that it isn't."

My one piece of advice would be to get together as many doctors letters as you can along with papers from the literature that support your case (you could do a pubmed search, or I could actually send you one or two articles that might support your case too - for example, I have one that discusses the long-term safety and efficacy of the SCS implant). These things might not help, but they sure can't hurt. The more educated you are about the procedure, the better.

Good luck!!!!

hugs,
Skeye
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