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skeye
Veteran Member


Date Joined Mar 2008
Total Posts : 2976
   Posted 2/26/2010 3:39 PM (GMT -7)   
Well, I heard from my insurance company today. They denied my second-level appeal for the neurostimulator. I'm both really upset and really angry. I specifically requested that I meet IN PERSON with the insurance company to present my appeal, yet they went ahead and did it anyway. I need to check with my surgeons office to make sure that they absolutely put that I writing (I was told they did at the time of submission), because if they did & the insurance company didn't honor that, then I have every right to sue them or at least get them to re-look at my appeal.

The whole reason that I wanted to meet in person was so that they couldn't pull any BS like they do otherwise. But instead they sent the appeal off to some no-name neurosurgeon in who knows where who doesn't even specialize in peripheral neuropathy (he's supposedly a spine surgeon & I'm sorry, but they face is NOT the spine).

They haven't heard the end of this from me, though. I've exhausted the entire appeal system that the insurance company offers, but I am allowed to further appeal by taking my case to the State Insurance Commissioner, which is what I am going to do (unless they insurance company blatantly ignored my in-writing request for an in-person hearing).

I'm just beside myself. I want this so badly. I have such a hard time just getting through each day. I'm absolutely miserable, to say the least. I was so hoping that the insurance company would say yes & that I could undergo the trial during spring break -- just under a month away. I had such good feelings about the outcome of this procedure. It just isn't fair - I know, most things in life aren't. But I just wish these people weren't so quick to brush me aside without having tried to live one day, or even one hour in my shoes. I bet you anything they couldn't do it.

Hope you're all having a better day than me. Thanks for listening to my angry, upset rant.

Skeye

Stac/Catz4
Regular Member


Date Joined Feb 2010
Total Posts : 358
   Posted 2/26/2010 4:08 PM (GMT -7)   
Oh Skeye,
I am so sorry for this really big, ugly, angry, messed up day! I've had the same. I hope you continue to stand up for your rights as a patient and follow through with this travesty! I would follow up with your doctor as you said and keep on keeping on. Please know that I am thinking of you and praying that you will find relief soon.
Cat(z4)
I'm called Cat, but as there are few other Cat's on here, I put the number of cats I have and combined it to spell out Catz4
DXed-Syringomyelia C-1 to T-1, Hypothyroidism, Diabetes Type II, IBS, Panic Disorder, ICC , Fibromyalgia, Migraines, Bipolar Disorder, Chronic Muscle Spasms, Torn Rotator Cuff in Left Shoulder, Had emergency surgery for ruptured bowel in '05 w/colostomy and takedown in '06.
Too many meds to name/Too many allergic reactions/sensitivities to too many drugs to name. Meds for Panic Disorder, Pain, Bipolar, IBS, Hypothroidism, Diabetes, Insomnia and then some.
 
 


Snowbunny21
Veteran Member


Date Joined Jan 2010
Total Posts : 3557
   Posted 2/26/2010 4:16 PM (GMT -7)   
Hi Skeye,

I am so sorry to hear about this news...I, unfortunately, don't have any health insurance right now as I'm not working and self pay is over $2000 a month because of my previous surgeries so that is impossible!!

I do remember how frustrating it is dealing with the 'pencil pusher' people at the insurance companies that are all about saving money for them and not caring much for the actual people they insure!

I actually traveled downtown to DC yesterday to picket near the Blair House where the President and other lawmakers had the health care summit...whatever anyone's politics are..we can all agree we need reform!!!...

Again..I am just so sorry to hear about this and pray that you can go to the higher ups in the company to fight this appeal...Keep trying...I know it's hard but don't give up...

I am sending you big hugs ((( )))
SB and "the pup who snores loudly" 
 
ACDF C5-C7, (no hardware), with autograft bone Nov. 2001
(reabsorption of bone 2 years later...still lost in body..expect to burp it out at anytime..haha")) 
ACDF with hardware, allograft bone Nov. 2005 
Anterior and Posterior CDF, allograft bone with BMP, removal of old hardware, use of titanium plates, rods, screws, & kitchen sink (lol) Dec 2006
 
PM since 2006


PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 2/26/2010 5:39 PM (GMT -7)   
Skeye,
I can't write the words here that I'd like to say to those insurance folks on your behalf (well, probably the same things you'd like to say!).

Just my two cents - I'd take that anger and channel it in the direction of the Insurance Commission, or an attorney or someone who can help you take the next steps. You know, it's not even hoops that we have to jump through for all these things; it's more like brick walls that get built and we have to chissle our way through, which is no easy feat!

Vent away! We're here to listen and support you. But don't give up!

Hugs,

PaLady

Screaming Eagle
Forum Moderator


Date Joined Sep 2009
Total Posts : 5005
   Posted 2/26/2010 5:58 PM (GMT -7)   
Good Evening Skeye, You can count on all of us for the best support. We all love you! Your so young and bright,and I get tickled when I get an email from you. And, of course you always have to remind me of your name! :) Our harts all cry for you, and we understand your frustrations with the systems out there. I wished I was the head of all Insurances and disability programs out there. When ever I would see a HW member come through....Approved! Approved!.... would be stamped on the paperwork! :)
Hang in there young one! Vent here all you want, anytime. Were pulling for you!

{SE}
DDD (Degenerative Disk Disease) S1-L4-L5, Heart Attack 2002, Angioplasty to clear blocked Artery and to implant Stent. Six Epidurals, Disocgram, Melanoma Cancer 07, Lumbar Fusion March of 2010, Four cortisone injections Tendinitis in Elbow.


Mrs. Dani
Veteran Member


Date Joined Jun 2009
Total Posts : 2787
   Posted 2/26/2010 7:10 PM (GMT -7)   
 
 
    Oh Skeye!
 
         Gosh I am so very sorry! *warm huggs* Of all the things for them to do! Their lack of understanding is beyond words! I am so very sorry they did it to you AGAIN! *hugg* And yes, by all means keep fighting. You have got to be worn so thin  from this increadibly heavy burdon, but don't give in to their antics. *warm huggs* I know that nothing I can say will take away the pain and frustraition you must surly be feeling, but please know you are in our hearts and prayers here. Keep fighting! Stay strong!
 
*warm huggs*
      dani


 

 

Two roads diverged in a yellow wood,
And sorry I could not travel both
And be one traveler, long I stood

 

 


MIKEL99
Veteran Member


Date Joined Feb 2010
Total Posts : 914
   Posted 2/26/2010 8:44 PM (GMT -7)   
Dear Skeye , I'm so soory your being treated this way , its so unfair ,those people are real so in so's .I wish I could help somehow , I really feel terrible about it , I mean what kind of people allow suffering ? I truly hope that one of avenues your using to appeal this unfairness works out sucessfully .
HIV+ also Hep c , need hip replacement surgery on hold because of unknown but cellulitus-like ailment  .most pain from hip condition and cellulitus-like ailment .hands numb may have carpal tunnel syndrome now . Great frustration because doctors unable to diagnos ailment              .Medecines - Oxycontin , percocet , Oxycondone , Celelbrex ,Avalox , lasix .


skeye
Veteran Member


Date Joined Mar 2008
Total Posts : 2976
   Posted 2/26/2010 9:12 PM (GMT -7)   
Friends,

Thank you so much for your wonderful words of support and understanding. Your posts brought tears to my eyes. I am so thankful to have you all.

I'm not giving up that easily. On Monday I will call my surgeon's office and find out whether or not they actually requested the hearing in writing. If they did, then I will find out what the next step is - calling the insurance company, getting a lawyer, etc. If the did not, then I will start to get together my appeal to the State Insurance Commissioner. On the bright side, the good thing about taking my case to the State Insurance Commissioner is that he has no connection with the insurance company & thus he won't be making his decision based on money.

Thank you all again for helping me get through this rough day!

hugs,
Skeye

nurse2
Regular Member


Date Joined Jul 2005
Total Posts : 229
   Posted 2/26/2010 9:33 PM (GMT -7)   

skeye,

about all I can do is say I'm very sorry to say the least. Everyone else has said it all. I know how frustrated you are and the best I can do is say a prayer that things will turn around for you.

Nurse2

 


Degenerative disc disease,osteoarthritis, status post 4 cervical spinal surgeries with plate insertions and fusion, Lupus, Sjogren's Disease, Fibromyalgia, chronic heacaches and chronic pain.
 
Find blessings in every day!
 


WhiteStone
Regular Member


Date Joined Feb 2010
Total Posts : 63
   Posted 2/26/2010 9:42 PM (GMT -7)   
Hi Skeye...I hate insurance companies, as I am sure you do too...so sorry those XXXX (I cannot write what I want to say here) have treated you in this way...all I can say is that I am sending caring thoughts and hoping someday the executives of these companies will be forced to use their own services...big hugs, J
It is better to conquer yourself than to win a thousand battles. Then the victory is yours. It cannot be taken from you, not by angels or by demons, heaven or hell. (Buddha)
 
Kindness in words creates confidence.
Kindness in thinking creates profoundness.
Kindness in giving creates love. (Laotzu)



White Beard
Forum Moderator


Date Joined Feb 2009
Total Posts : 3611
   Posted 2/26/2010 11:47 PM (GMT -7)   
SKEYE
I am so sorry, I do know how much you were counting on this, and I do feel you have every right to be upset and mad about this. I do hope that you can successfully challenge them! You deserve at least to have the chance of trying this procedure out! Skeye give them H***!!!! They deserve it! I keep you in my thoughts and prayers!

I wish you only the BEST and I hope that my wish comes true!

Good Luck to You Skeye!

White Beard

edt
Veteran Member


Date Joined Dec 2008
Total Posts : 773
   Posted 2/27/2010 7:13 AM (GMT -7)   

Skeye,

I am so sorry this has happened......keep your fighting spirit, YOU WILL WIN!! 

XXOO
Patti


catahoula
Regular Member


Date Joined Dec 2009
Total Posts : 184
   Posted 2/27/2010 12:09 PM (GMT -7)   
Skeye- How do I say this like Aa lady? You are such an inspiration and this is so unjust. Yell, scream, then take a deep breath and keep on keepin on. Keep fightin the insurance. Have you considered going to the hospital and asking them to wave the charges? I know...when you finish laughing at the thought of the healthcare system actually doing some health care for its patients, there is a certain amount of money set aside by each institution for cases ( you all know the word, I can't think of it thanks to all the meds floating in my head). It might be worth it to talk to the social service dept at the hosp. where the procedure would be done. I don't know why and am afraid I am still dreaming but I had the nerve stim done, trial and perm. Insurance was suppose to pay because it was outpatient, one day. They said it was no problem. I was working and had a PPO at the time. After I had everything done, THEN insurance changed its mind, said it was experimental and hit me with an $82,000.00 bill. It could have been 82 million because with 2 kids in college, me going on disability, mounting med nills, there was just no blood coming out of this stone. We started the fight. Did due dilagence and stated we were told that since they said it was out-patient and was covered, started the appeal process. Then one day, out of the blue I got a phone call from the billing dept at the hosp. saying that the bill had been taken care of. After I picked my jaw up from the floor,I asked for that in writing. I'm still not sure what happened to make it get written off. Someone didn't do their homework but I think a good place to start would be social services at the hospital.
Also, it wouldn't be a bad idea to talk to a reporter at the local newspaper , just a community interest story about the plight of another "poor soul" being affected by the economy and healthcare. Sometimes you have to "throw yourself on the mercy of the court" as it were. The squeaky wheel approach is one way you can try now.

good luck and warm warm hugs

painfree weekend to you all

Cata

(Please refrain for any swearing whether it's cryptic or not. Read the forum rules before posting again.)

Post Edited By Moderator (Chutz) : 2/27/2010 3:52:56 PM (GMT-7)


Chartreux
Veteran Member


Date Joined Aug 2006
Total Posts : 9622
   Posted 2/27/2010 2:32 PM (GMT -7)   
Hey Skeye,
I wanted to wish you good luck in your fight against this insurance company. It'll be a hard battle.
I was recently denied a procedure based on it not being FDA approved and it was approved by the FDA on 7 Nov 2003, only as I'm so sick I missed my chance/deadlines,
So I'll be hopeing that your case gets heard and that you get a favorable outcome. fingers crossed for you on this.
But this could take time and I hope you can get yours thru fast.
Lots of 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"...

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


IsThereAnEnd?
Regular Member


Date Joined Feb 2010
Total Posts : 66
   Posted 2/27/2010 2:40 PM (GMT -7)   
Skye ~
I am SO, SO sorry you are having to go through this! :( I know how difficult it is to deal with CP - then top insurance nightmares on that and it's no wonder we all don't go completely CRAZY!!!! I wish you the VERY, very best and please know we are all here for you - anytime! Sending you lots of (((((hugs)))))))) ~ hang in there!
Huuuggggsss!
Cardiomyopathy, Celiac Disease, High Blood Pressure, 2 Fusions @ L4, L5, S1, 2 Fusions @ C7 & C8, Implantible bone growth stimulator cervically, and soon to have Neurostimulation Therapy to treat lumbar, Chronic Pain Sufferer for 8 years, take several meds daily to survive! Looking for a miracle I think ~


Blessedx8
Veteran Member


Date Joined Aug 2008
Total Posts : 3193
   Posted 2/28/2010 4:09 PM (GMT -7)   
Skeye...

I don't blame you for being so frustrated! I'm so sorry that you are having to go through all of this.... that you need something so badly... and someone is making the decision to prevent you from having it!!! Like you said, I would dare the person/people to walk for one day in your shoes. You are right, absolutely... it isn't fair at all.

I'll keep you in my prayers... and I hope you can ultimately get this thing that you so need, Skeye. Try to hang in there in the meantime.

--Tina
Main Health Problems: Dysautonomia/POTS; CFS/Fibromyalgia; Severe Hypertension; Hypothyroidism; Hypoadrenalism; Mixed (Obstructive/Central) Sleep Apnea - on Auto BiPap; Depression/Anxiety; Severe Vitamin D Deficiency

Pain Issues: Cervical/Thoracic back pain; migraines; carpal tunnel syndrome; widespread joint/muscle pain, nerve pain in hands/arms/feet; Future Plans: Intrathecal Pain Pump; already completed trial (Sept, 2008); awaiting my decision for implantation

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


skeye
Veteran Member


Date Joined Mar 2008
Total Posts : 2976
   Posted 2/28/2010 7:21 PM (GMT -7)   
Thank you all again for your kind words & support! You guys are getting me through this.

hugs,
Skeye

PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 2/28/2010 9:18 PM (GMT -7)   
Skeye,
I know I have admired how you persevere with all the challenges you face, so make sure you give yourself the credit you deserve! I remember when you weren't sure if you could get through this last year - and I know it hasn't been easy - but here you are only a few months from graduating!

We're proud of you!

PaLady

golitho
Veteran Member


Date Joined Sep 2008
Total Posts : 1670
   Posted 2/28/2010 10:55 PM (GMT -7)   
Oh Skeye, how absolutely frustrating for you. My heart is with you, the bureaucracy of it all drives me insane.

Why can't these faceless people who have such control over our lives being a little humane? Why is it too much to ask them to try a trial?

I so hope you have some success with this next level of appeal, what a waste of your time! But it will all be worth it if you get some positive outcome. Is it possibe to get a trial of the equipment via any other route? Like the company who makes the apparatus? Could they possibly cover you trying it to see if their stimulator works for eyes?

I know I'm clutching at straws.

I really wish you luck. I just started teaching my autumn(fall) term today and I always think of you when I'm with my students. I look out at the sea of new faces and wonder if any suffer from CP. I work it into my spiel for some more practical classes so I can get the disability unit on hand to help them. But I always think of you struggling away with your classes.

Sending you some relaxing vibes, golitho

skeye
Veteran Member


Date Joined Mar 2008
Total Posts : 2976
   Posted 3/2/2010 7:21 PM (GMT -7)   
Quick update: It was the doctor's office that screwed up. They didn't put it in writing that I wanted to meet with the insurance company in person (even though I was told at the time that they did request an in person meeting). So now the next step is to submit an appeal to the state Insurance Commissioner. I was told that neurosurgeon was going to dictate a letter tonight & that the appeal would be sent off before the end of the week. I think they then have up to 30 business days to come to a decision. Wish me luck! I could use all the help I can get!

Skeye

PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 3/2/2010 7:52 PM (GMT -7)   
Skeye,
I'm wishing you all the luck in the world! You deserve nothing less!

I remember how you were trying to call your doctor's office to confirm all this and couldn't get a response. Sometimes it's beyond frustrating - when we know they're busy, but what's a little thing to them can have significant consequences for us.

Are they going to send or fax you a copy of that letter? I'd sure want one. Ask they send you one at the same time they send out the original, and this way you'll know about when it actually got in the mail, and can call the Insurance Commission to confirm receipt.

Good luck!!!!!

PaLady

bsjaguar
Veteran Member


Date Joined Jun 2009
Total Posts : 974
   Posted 3/3/2010 4:16 AM (GMT -7)   
Skeye, all I can add is my well wishes. Sorry you have to go through all this stress!
---Jag---
 
DDD, osteoarthritis, facet syndrome, fusion surgeries C-5/7 & L-4/5 both in 2006, torn meniscus surgeries left knee 2000 & 2002, buldging disc L-2/3


Pete trips again!
Veteran Member


Date Joined Nov 2006
Total Posts : 1899
   Posted 3/3/2010 4:34 AM (GMT -7)   
Skeye,
Sorrry I haven't been around to give you any support throughout your ongoing battle w/ these jerks! To say what they have done to you isn't fair seems like such an understatement! So I'll just say what I feel>>> Insurance companies really really SUCK!!! Karma is going to git those boogers!
Hang tough my little Sister!
Love and big fat guy Hugs comin atcha!
Pete

Mrs. Dani
Veteran Member


Date Joined Jun 2009
Total Posts : 2787
   Posted 3/3/2010 9:24 AM (GMT -7)   
 
 
   Dear Skeye,
 
     Good morning! *hugg* I hope you have been able to get some much needed rest. I am sure the insurance night mare must be weighing on you terribly. I am sorry you have to go through it all.
 
      I sure hope everything is submitted properly this time! You will be in our hearts and prayers here. I know you have been through alot but stay strong!!!!
 
*huggs*
   dani

 

 

Two roads diverged in a yellow wood,
And sorry I could not travel both
And be one traveler, long I stood

 

 


Scarred_for_life
Veteran Member


Date Joined Jul 2008
Total Posts : 1559
   Posted 3/3/2010 11:29 AM (GMT -7)   
Hi stray! Gosh this is so frustrating! I know how you have been so excited about doing the stim and now the ins messes the whole thing up....so like them!!!! Gosh just thinking about your situation makes my blood boil. How come they are so knowledgable that they get to make the decisions for each of our health care???? It's just not fair!!!!

I gotta tell you that the last two times I have been told by the psychs that the neuro is in the picture I have told my WC claims gal about it. Well, this time I have not said a word to her about the approval by the psych doc. What has happened to you is exactly the reason I am not getting my hopes too high. They can find any reason to not pay for something and I just don't wanna get my hopes too high and find that it gets pulled out from underneath me at the last second.

I will be crossing fingers and toes for your appeal to go through dear and please don't get your stress up to high....you know what happens with your pain.

Hugs

Scarred
I live to "Tame My Pain!" 

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