Some good news

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skeye
Veteran Member


Date Joined Mar 2008
Total Posts : 2976
   Posted 3/26/2010 5:59 PM (GMT -7)   
As many of you know I have been fighting my insurance company for several months in order to be allowed to undergo a trial of a neurostimulator. A few weeks ago I got a letter from them saying that they denied my second level appeal & that I had exhausted their internal appeal process & my only remaining option was to take my case to the state Insurance Commissioner.

Tonight I got a completely unexpected letter in the mail from my insurance company saying that they are going to re-open my case & let redo my second-level appeal in the form of an in-person hearing.

On the suggestion of my insurance agent, we sent the insurance company a letter a week or two ago saying that I had wanted an in-person hearing & the doctor's office screwed up my request & that I'd appreciate it if they'd reconsider their decision. Last week the insurance company told my agent over the phone that my request had been denied, so when I opened the letter from the insurance company today I expected it to say such a thing. Instead I was pleasantly surprised to find just the opposite!

I'm so thrilled! There is no guarantee that they will overturn their original denial of the stimulator, but at least I have a second chance & can present my case in person! I had been really upset because earlier this week I got all the neurosurgeon's letters to the insurance company & they were AWFUL! They said NOTHING except that I was scheduled for such & such procedure on such & such date & that unfortunately the insurance company denied it & that he'd like them to reconsider. It was no wonder the insurance company said no. I was really surprised because I really like the guy & he is a world-class surgeon.

My father & I wrote a really strong letter to the Insurance Commissioner asking him to overturn the decision of the insurance company, but we will now hold off on sending that until after the hearing with the insurance company. He also wrote a letter to my neurosurgeon requesting that he take a look at the letter we wrote & write a new letter.

The hearing is scheduled for Tuesday April 6th. Wish me lots of luck!

Skeye

edt
Veteran Member


Date Joined Dec 2008
Total Posts : 773
   Posted 3/26/2010 6:12 PM (GMT -7)   

Oh SKEYE,

This is great news, everything I can cross is crossed for a most needed APPROVAL!!

(((((((((((((((((((((Skeye)))))))))))))))))))

XXOO
Patti


tmjpain
Veteran Member


Date Joined Oct 2008
Total Posts : 2022
   Posted 3/26/2010 6:17 PM (GMT -7)   
OMGosh Skeye, this is fantastic news!!! You will get it my friend!! This will be in your favour. Think positive and i will pray for you!!!!!

Hugs
   
SUZANE
      
 Chronic, severe and continuous bilateral temporal headaches since April 2000.
 Poor prognosis, seen thousands of doctors, been on dozens of meds and tried all forms of treatment with no success.
 Currently Feb 2010: cycles of IV Ketamine infusion via a PICC line and pump at home with some success.
 Meds: oxycodone for breakthrough, cymbalta, vitamin D, B12, magnesium, omega 3, melatonin
 Profession: Part time registered nurse on Long term disability and applying for permanent disability thru CPP
 52 yrs old, female, married, two boys 19 & 21, live in Ottawa, Ontario, Canada
 
           


Mrs. Dani
Veteran Member


Date Joined Jun 2009
Total Posts : 2787
   Posted 3/26/2010 6:18 PM (GMT -7)   
 
 
   Dear Skeye,
 
     This is fantastic news. I hope they are truly going to give your appeal a real chance this time. I know you have had many many heartbeaking let downs. I hope this is the time they truely help you. You are always in our prayers and hearts. Stay strong!!!
 
*hugg*
  dani

 

 

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

 

 


Blessedx8
Veteran Member


Date Joined Aug 2008
Total Posts : 3193
   Posted 3/26/2010 9:27 PM (GMT -7)   
When I saw the title of your post...I was hoping that it was good news re: getting your neurostimulator... You've gone through so much trying to get that darn thing. I know there is no guarantee...but I am really, really glad you get another chance.

I will pray that you get approved this time, Skeye... Hang in there.
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


bluejet2
Regular Member


Date Joined Feb 2009
Total Posts : 487
   Posted 3/26/2010 9:38 PM (GMT -7)   
Hi Skeye:

I, too, will be praying really hard that you get the approval you so richly deserve!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Lorie

PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 3/27/2010 12:42 AM (GMT -7)   
Skeye,
This is wonderful news! At least your request was heard and reconsidered seriously! Maybe your insurance agent said something to them on the phone call, but whatever the reason I'm thrilled for you!

I'm also glad you got the info. your doc sent in so that you can see how deficient it was and have a chance to address that. You know I think this is the case in far more cases than we realize. I know as I've collected my medical records I've generally been disappointed at how much was lacking. I know doctors are busy, but they may not realize just how much that means to us in our struggles for treatment, financial help, etc.

I hope this gets you the trial you so deserve with the SCS!

Cheers to you!

PaLady

MIKEL99
Veteran Member


Date Joined Feb 2010
Total Posts : 914
   Posted 3/27/2010 1:09 AM (GMT -7)   
Hey Skeye , Best of luck to you brother may God bless you and help you and your cause , I wish and hope with all i can that you get the decision you need .As someone who also has to wait for others to make decisions about aspects of his life I know how frustrating it can be . Try to remain calm and try (I know its very difficult)to go without expection , but with a positive attitude ,Good Luck my friend !!!!!
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 -   Celelbrex ,viracept,truvada, lasix .    '                                                                                                                         


Pete trips again!
Veteran Member


Date Joined Nov 2006
Total Posts : 1899
   Posted 3/27/2010 3:31 AM (GMT -7)   
Oh Skeye, I wrote that I wouldn't be posting here anymore for reasons I'd rather not bring up but when I read your good news, I had to write!!! Oh I'm soooooo happy for you my dear girl! You go give them hell! I just know that you will win this time!! Is your Father going to be there to speak also? If so, I'm sure the tag team of Skeye & Pops will come out victorious this time!!!
I'll be prayin for you Little Sister!!!
Big Hugs>Your Buddy,
Pete!
When I was young & stupid I broke almost every bone in my body and I'm paying a heavy price now but I'm still here and so glad to see my two sons grow up to be fine young men, both are in the Navy. I'm so proud! 


Retired Mom
Veteran Member


Date Joined Feb 2010
Total Posts : 1753
   Posted 3/27/2010 5:23 AM (GMT -7)   
Congratulations Skye,

I'll keep you in my prayers.
Formerly PrayingForRealRelief...
 
DDD, CHRONIC PAIN SYNDROME, TLIF L5-S1 2009 (failed), FIBRO, MINEYER'S (SP?), VERTIGO, MIGRAINES, GERD, SLEEP DISORDER, NISSEN FUNDOPLICATION (failed), DEPRESSION, EXTREME ANXIETY DISORDER, OCPD, PTSD, CHRONIC MUSCLE SPASMS, HUMAN GROWTH HORMONE DEFICIENCY, VITAMIN D DEFICIENCY, CARPLE TUNNEL SYNDROME, EXTREME IDIOPATHIC HYPOGLYCEMIA FROM AGE 12
 
 
 
 


catahoula
Regular Member


Date Joined Dec 2009
Total Posts : 184
   Posted 3/27/2010 8:26 AM (GMT -7)   
Keeping fingers and toes crossed. Have been thinking of you. I know it will happen for you!
Keep on fighting
You will succeed
Cata(houla)
sick and tired of being sick and tired


skeye
Veteran Member


Date Joined Mar 2008
Total Posts : 2976
   Posted 3/27/2010 3:52 PM (GMT -7)   
Thanks so much for the support everyone! I really appreciate it!!!

Skeye

Snowbunny21
Veteran Member


Date Joined Jan 2010
Total Posts : 3557
   Posted 3/27/2010 3:56 PM (GMT -7)   
Yea Skeye...I am so happy to hear the good news! I will continue prayers for things to keep going forward to help with your pain..

Sending you a happy hug (( ))
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
 
 


kimber9807
Regular Member


Date Joined Jan 2010
Total Posts : 492
   Posted 3/28/2010 10:10 AM (GMT -7)   
Good Luck Skeye. I will be praying for you.
im dxed with  herniated discs,fibromylagia , scolosis,ddd,athritis, spinal stenosis ,gerd,gastric ulcer,gastroparesis..gallbladder removal 3/23/10.
 
meds,ambien, prilosec otc,lortab ,reglan,flonase and  trazodone.


Chartreux
Veteran Member


Date Joined Aug 2006
Total Posts : 9622
   Posted 3/29/2010 2:07 PM (GMT -7)   
Good Luck to you Skeye, Sure hope you win...
Prayers and lots of soft hugz...
(((((((((((((((((((((((((((((((((Skeye))))))))))))))))))))))))))))))))))))))))))))))))))))))
make sure to keep us posted, okay...
**********************************************
* 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"...

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


Screaming Eagle
Forum Moderator


Date Joined Sep 2009
Total Posts : 5005
   Posted 3/29/2010 5:20 PM (GMT -7)   
Skeye, just a quick note to let you know that I'm thinking of you too! It's probably noticeable that I'm still under the weather here, but I am getting better little by little.

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.


nurse2
Regular Member


Date Joined Jul 2005
Total Posts : 229
   Posted 3/31/2010 7:32 PM (GMT -7)   
Skeye, This is wonderful news and such a little sliver of hope for the rest of us who are still fighting for attorneys to hear something concerning our cases. Bravo!
Nurse2
Degenerative disc disease,osteoarthritis, status post 4 cervical spinal surgeries with plate insertions and fusion, Lupus, Sjogren's Disease, Fibromyalgia, bilaterial knee replacements, total left shoulder replacement, years of chronic headaches and chronic pain, asthma.
 
Find blessings in every day!
 


skeye
Veteran Member


Date Joined Mar 2008
Total Posts : 2976
   Posted 4/7/2010 1:56 PM (GMT -7)   
Hi everyone,

I apologize for being scarce the last week or two. I haven't been feeling very well, so it's been hard for me to get online & read.

I had my hearing with the insurance company yesterday. It was pretty intimidating. I sat down at this big conference table across from 6 people (facilitator, medical director for the insurance company, an insurance company nurse, and several people from other departments) & with the exception of the facilitator, who was cvery nice, they all had stone-cold expressions on their face the entire time. We did our best to present my case, but honestly I wasn't super optimistic coming out of it, because I have a very hard time showing other people (especially unfamiliar people) my emotions & I wasn't sure I did a good enough job showing them how much my pain impacts my life. But it must have gone over better than I thought because a couple hours later I got a phone call saying that THEY APPROVED my stimulator trial!!!

I'm absolutely thrilled! It won't be official until I get the letter in the mail, but I've already tentatively scheduled the trial for the end of May, after I graduate. I'm so relieved that this whole mess is finally over! Now I just have to make it until graduation (May 23rd). Thank you all so much for your support! I couldn't have gotten through this without you all!

Skeye

PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 4/7/2010 2:03 PM (GMT -7)   
Skeye,
CONGRATULATIONS!!!! yeah yeah yeah

I'm jumping up and down cheering for you (well in my mind, my body can't do the jump thing!).

It's so great that it will come right after graduation, too. And GRADUATION! I remember last summer when you weren't sure you could get through the school year, and I know it has been a huge challenge for you but you're just about at the finish line!

You are going to make great contributions, I just know it!

I'm thrilled for you, Skeye!

Many many hugs and cheers coming your way! yeah yeah yeah

PaLady

Chartreux
Veteran Member


Date Joined Aug 2006
Total Posts : 9622
   Posted 4/7/2010 2:19 PM (GMT -7)   
WooHoo Skeye,
great job...and good luck with your graduation...
Do you have a job lined up???
So glad you got approved by the insurance company, you'll have to coach me..so when I'm up to it I can get my procedure approved...
HUGZ
Way to go...
((((((((((((((((((((((((((((((((((((((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 4/7/2010 2:25 PM (GMT -7)   
YEAH!!!!!! I am so happy for you. It'll be a breeze. You are so deserving.
Catahoula
sick and tired of being sick and tired


Screaming Eagle
Forum Moderator


Date Joined Sep 2009
Total Posts : 5005
   Posted 4/7/2010 2:56 PM (GMT -7)   
Oh Boy Skeye! I just now saw this posting! So disregard the other reply you made on another post. I for one ,and many others here have been following you through this process, and we are so happy that you have been approved! A Very Big Wahoo to you! This is wonderful news. Congratulations to you! Nice Job!

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.


Blessedx8
Veteran Member


Date Joined Aug 2008
Total Posts : 3193
   Posted 4/7/2010 3:57 PM (GMT -7)   
Skeye...

I was hoping to read this news from you one day :) I'm really happy for you!!

Also, I proud of you for making it to graduation :)

--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


skeye
Veteran Member


Date Joined Mar 2008
Total Posts : 2976
   Posted 4/7/2010 4:40 PM (GMT -7)   
Thank you all for the congratulations! I'm beaming! I just hope that the trial is successful in providing substantial relief. I have a good feeling about it, as do my doctors, so maybe a positive attitude will help! It certainly can't hurt!

Char - I'll be working (at least temporarily) as a vet tech at the same practice at which I currently work. However, the only current opening is part-time, so I'll stick with the part-time position for the summer (and hopefully get to relax some at the same time, and time to study for the GRE's -- ugh) & depending on the availability of a full-time position come this fall, I will either stay where I am or look for a job at a veterinary practice elsewhere. I have some substantial loans to pay off & have to save up for vet school tuition, so I really need to work full time.

Skeye

PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 4/7/2010 5:03 PM (GMT -7)   
Skeye,
I'm so glad you're beaming - you should be! I don't normally have tears brought to my eyes but this good news for you on top of your graduation is really moving to read. Maybe it's the old prof. in me; I wish I could see you walk up on the stage and get your diploma!

GRE's, eh? Wow - you're not stopping! You go girl! I didn't mind the GRE's as much as the Miller Analogies but I don't know if they require those anymore. I'll be hoping that your stim. trial is successful, so you can get some relief as you look forward to vet school. I wonder if any of the new student loan programs, or programs that would allow you to work off your debt would apply in your field. Just a thought.

It'll happen for you. I just know it!

Hugs and Cheers,
PaLady
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