Re: denied again by insurance

[Guest guest]

You go girl! Beth, I hope you get what you requested....its not too much to ask. I was very lucky to have it covered, my hubby has great coverage, but I did have to pay for the lift, which I did not mind. I felt lucky enough as it was. I sent off over 20 pages of medical findings, stapled to studies that are out, with two doctors letters, asking to make surgery a medical neccessity. For instance, I stapled my two large thyroid nodule cat scans and difinite findings by the along with the NCCI new research that implants place women at a higher risk for cancer, seeing that I had nodules that were large and my docs were concerned about, I put them together. That this was a medical nessessity to cover for medical reasonings. I also sent studies regarding connective tissue disease, and that I had a positive rhueamtoid factor and ANA with docs letters to back it up. As well as all my stange symptoms with neuro symptoms that could not be explained by multiple wasted tests......They had to vote on it, and it took over 3 grueling weeks to decide, as it is not normally covered. Thank you Lord, it was. I found that if God wants to go this way, it is all made out for you..meaning the path is set- Some things may be hard, but overall the whole process goes smoothly, and it all seems to work out in the end.... I hope all goes well for you, Beth! >From: "bethlakey" <bethlakey@...> >Reply- > >Subject: denied again by insurance >Date: Wed, 26 May 2004 17:49:14 -0000 > > Oh well, I've been kind of bummed. I got my second denial from >my HMO to reimburse me for surgery. I thought about just letting it >go, and decided I can't do that. For starters, they will cover >complications from cosmetic surgery. And second, they waited until >I was almost disabled to give me a referral. And third, I was >insulted by their nasty rheumy. who said there was nothing >physically wrong with me and I should see a psychiatrist. I think >that was when I decided to declare war. > Yesterday I contacted my company representative and asked for the >Medical Director's name and address, etc. I got a call from the >HMOs corporate headquarters a few hours later wanting to discuss my >appeal. I returned the call this morning, so I guess I'll see what >happens. > All I want is reimbursement for the portion they would have paid >a contracted provider. I don't think that's too much to ask. >Thanks for listening. > >:)Beth > > > > >

[Guest guest]

Yep, go for it. If they turn it down, have an atty. send them a letter.

Lynda

At 11:49 AM 5/26/2004, you wrote:

> Oh well, I've been kind of bummed. I got my second denial from

>my HMO to reimburse me for surgery. I thought about just letting it

>go, and decided I can't do that. For starters, they will cover

>complications from cosmetic surgery. And second, they waited until

>I was almost disabled to give me a referral. And third, I was

>insulted by their nasty rheumy. who said there was nothing

>physically wrong with me and I should see a psychiatrist. I think

>that was when I decided to declare war.

> Yesterday I contacted my company representative and asked for the

>Medical Director's name and address, etc. I got a call from the

>HMOs corporate headquarters a few hours later wanting to discuss my

>appeal. I returned the call this morning, so I guess I'll see what

>happens.

> All I want is reimbursement for the portion they would have paid

>a contracted provider. I don't think that's too much to ask.

>Thanks for listening.

>

>:)Beth

>

>

>

>

>

[Guest guest]

beth - DO NOT GIVE UP!!! I went through the same crap last year and did appeal after appeal - they want you to give up. have you had your implants analyzed? I did and it proved not only that they were leaking but they were full of mold, etc. I sent them all that crap and never let up. It took a while but I got my check!!

shari

[Guest guest]

ok, thanks Sharri. Do you think I should try to contact the medical

director of my organization, whose names appears to be very

secretive, or should I try contacting my local state insurance

commissioner? Dr Blais has my implants somewhere and can't get to

them right now. I suspect they are probably ok, but that I just had

a very bad reaction to a foreign body. I mean I started having

problems with them on the second day. My body never liked them.

But the main point is that my insurance will take them out, just

waited too long to give me a referral, and then referred me to

someone I had never heard of. I had to take my health at that point

into my own hands. I feel bad for my mom, who is a retired

schoolteacher living on a fixed income, and paid for most of the

surgery.

Thanks,

Beth

> beth - DO NOT GIVE UP!!! I went through the same crap last year

and did

> appeal after appeal - they want you to give up. have you had your

implants

> analyzed? I did and it proved not only that they were leaking but

they were full of

> mold, etc. I sent them all that crap and never let up. It took a

while but

> I got my check!!

>

> shari

[Guest guest]

I'm with an hmo. They are notorious for not wanting to pay. I am

thinking about appealing to my state insurance commissioner, if

nothing else, to let them know how dissatisfied I am with my

treatment over the past year. I had wanted to contact the medical

director, but they seem to have a mysterious name that no one

knows,hee hee, so maybe I'll try the state. What do you think? I

have sent in copies of all my tests, letter of medical necessity, my

own imploring letter, don't know what else to send, since I had my

implants a very short time and didn't have a whole lot of tests or

see that many doctors.

They keep telling me I used a doctor not on their plan and that's

why I am being denied. They were going to send me to someone who was

clueless about enbloc and let them use me as a guinea pig, plus the

referral came in about a day before I had surgery with Dr Kolb.

I still know I made the right decision, no matter what the outcome.

hugs,

Beth

[Guest guest]

Heck I would contact everybody you can. Don't give up as that is exactly what they want you to do - I have an HMO also and they go out of their way to make things difficult so you don't get the medical treatment you need - this is how they make money. Most people will just give up or give in. Keep fighting!

shari

[Guest guest]

I'm so sorry Beth. HMOs SUCK! Sorry, but don't some of you here in the US wish we had national health care? Though I've not had money issues in getting to obtain medical care, it sure is frustrating dealing with an insurance company who's goals are to profit. This is in direct opposition to the best interest of the patient--it's fundamentally wrong and immoral in my opinion. I'd rather pay more taxes.

LMbethlakey <bethlakey@...> wrote:

Oh well, I've been kind of bummed. I got my second denial from my HMO to reimburse me for surgery. I thought about just letting it go, and decided I can't do that. For starters, they will cover complications from cosmetic surgery. And second, they waited until I was almost disabled to give me a referral. And third, I was insulted by their nasty rheumy. who said there was nothing physically wrong with me and I should see a psychiatrist. I think that was when I decided to declare war.Yesterday I contacted my company representative and asked for the Medical Director's name and address, etc. I got a call from the HMOs corporate headquarters a few hours later wanting to discuss my appeal. I returned the call this morning, so I guess I'll see what happens.All I want is reimbursement for the portion they would have paid a contracted

provider. I don't think that's too much to ask. Thanks for listening.:)Beth

[Guest guest]

Agree with you there...profiting off the ill seems

absolutely immoral to me. There should be a balance

here, but I see absolutely no indication of balance

anywhere in America's health care system. It is a

greedy business.

Patty

--- Jane Doe <oceanlilly_csu@...> wrote:

> I'm so sorry Beth. HMOs SUCK! Sorry, but don't some

> of you here in the US wish we had national health

> care? Though I've not had money issues in getting to

> obtain medical care, it sure is frustrating dealing

> with an insurance company who's goals are to profit.

> This is in direct opposition to the best interest of

> the patient--it's fundamentally wrong and immoral in

> my opinion. I'd rather pay more taxes.

> LM

>

> bethlakey <bethlakey@...> wrote:

> Oh well, I've been kind of bummed. I got my second

> denial from

> my HMO to reimburse me for surgery. I thought about

> just letting it

> go, and decided I can't do that. For starters, they

> will cover

> complications from cosmetic surgery. And second,

> they waited until

> I was almost disabled to give me a referral. And

> third, I was

> insulted by their nasty rheumy. who said there was

> nothing

> physically wrong with me and I should see a

> psychiatrist. I think

> that was when I decided to declare war.

> Yesterday I contacted my company representative and

> asked for the

> Medical Director's name and address, etc. I got a

> call from the

> HMOs corporate headquarters a few hours later

> wanting to discuss my

> appeal. I returned the call this morning, so I guess

> I'll see what

> happens.

> All I want is reimbursement for the portion they

> would have paid

> a contracted provider. I don't think that's too much

> to ask.

> Thanks for listening.

>

> :)Beth

>

>

>

>

>

>

[Guest guest]

this is just food for thought, but I have a friend who lives in Canada.....free healthcare, right. Her father waited over 3 months to have surgery for prostate cancer due to the hospital being over booked. Free healthcare is not as great as some think. There are problems with our system as well but I wouldnt look for our Congress or Sentate to fix it anytime soon.Jane Doe <oceanlilly_csu@...> wrote:

I'm so sorry Beth. HMOs SUCK! Sorry, but don't some of you here in the US wish we had national health care? Though I've not had money issues in getting to obtain medical care, it sure is frustrating dealing with an insurance company who's goals are to profit. This is in direct opposition to the best interest of the patient--it's fundamentally wrong and immoral in my opinion. I'd rather pay more taxes.

LMbethlakey <bethlakey@...> wrote:

Oh well, I've been kind of bummed. I got my second denial from my HMO to reimburse me for surgery. I thought about just letting it go, and decided I can't do that. For starters, they will cover complications from cosmetic surgery. And second, they waited until I was almost disabled to give me a referral. And third, I was insulted by their nasty rheumy. who said there was nothing physically wrong with me and I should see a psychiatrist. I think that was when I decided to declare war.Yesterday I contacted my company representative and asked for the Medical Director's name and address, etc. I got a call from the HMOs corporate headquarters a few hours later wanting to discuss my appeal. I returned the call this morning, so I guess I'll see what happens.All I want is reimbursement for the portion they would have paid a contracted

provider. I don't think that's too much to ask. Thanks for listening.:)Beth

[Guest guest]

I have a PPO here in Idaho and to be honest I miss my HMO in Ca, I

know most people hate them, but I knew how to work the system and it

was so much cheaper than this PPO crap we deal with now. Plus with

the HMO I never had to see all this damn paper work, yuck. I guess

the disadvantage is if you don't like the Dr's they chose for you. I

always managed to find a way to get one I liked, I had several great

docs in CA on my HMO, here in Idaho I have only found 2 that I liked

through my PPO. But there are less to chose from here too.

I guess it depends on where you are and what the situation.

-

, Jane Doe <oceanlilly_csu@y...> wrote:

> I'm so sorry Beth. HMOs SUCK! Sorry, but don't some of you here in

the US wish we had national health care? Though I've not had money

issues in getting to obtain medical care, it sure is frustrating

dealing with an insurance company who's goals are to profit. This is

in direct opposition to the best interest of the patient--it's

fundamentally wrong and immoral in my opinion. I'd rather pay more

taxes.

> LM

>

> bethlakey <bethlakey@y...> wrote:

> Oh well, I've been kind of bummed. I got my second denial from

> my HMO to reimburse me for surgery. I thought about just letting it

> go, and decided I can't do that. For starters, they will cover

> complications from cosmetic surgery. And second, they waited until

> I was almost disabled to give me a referral. And third, I was

> insulted by their nasty rheumy. who said there was nothing

> physically wrong with me and I should see a psychiatrist. I think

> that was when I decided to declare war.

> Yesterday I contacted my company representative and asked for the

> Medical Director's name and address, etc. I got a call from the

> HMOs corporate headquarters a few hours later wanting to discuss my

> appeal. I returned the call this morning, so I guess I'll see what

> happens.

> All I want is reimbursement for the portion they would have paid

> a contracted provider. I don't think that's too much to ask.

> Thanks for listening.

>

> :)Beth

>

>

>

>

>

>

[Guest guest]

Hey ,

I'm in Ga and I think they are very cookie-cutter to me, if that

makes sense. They can't seem to think outside the box. That's why

when I got sick, I had to find Dr Kolb on my own. Those folks were

going to let me become disabled, and just sit by and watch I guess.

Plus, one of their specialists told me there was nothing physically

wrong with me. I don't need to be paying top dollar to see people

like that. At least with a POS that is coming in the Fall, I will

be able to pick and choose my doctors. The pediatrics in my HMO is

awesome, can't say that for the adult docs. I have heard the CA

group is much better.

> > Oh well, I've been kind of bummed. I got my second denial from

> > my HMO to reimburse me for surgery. I thought about just letting

it

> > go, and decided I can't do that. For starters, they will cover

> > complications from cosmetic surgery. And second, they waited

until

> > I was almost disabled to give me a referral. And third, I was

> > insulted by their nasty rheumy. who said there was nothing

> > physically wrong with me and I should see a psychiatrist. I

think

> > that was when I decided to declare war.

> > Yesterday I contacted my company representative and asked for

the

> > Medical Director's name and address, etc. I got a call from the

> > HMOs corporate headquarters a few hours later wanting to discuss

my

> > appeal. I returned the call this morning, so I guess I'll see

what

> > happens.

> > All I want is reimbursement for the portion they would have paid

> > a contracted provider. I don't think that's too much to ask.

> > Thanks for listening.

> >

> > :)Beth

> >

> >

> >

> >

> >

> >

[Guest guest]

Probably so, plus I had inside info as I worked at Stanford and knew

who were the good docs and which ones to steer clear of. One of the

advantages of being in the health care profession. I really had

issues with one rheum on my plan and they immediately sent me to

another who was awesome. I mean none of them would admit it was my

implants, Dr Feng was the one who told me she thought it was my

implants and that she felt I could get better if she took them out. I

spoke with Dr Kolb too, and she felt I could find someone in CA to

take them out, but I did not find anyone there I liked or trusted, so

I went to Ohio and am pleased that I did. I am doing so well now that

I know I made the right choice for me. I did some dieting and

detoxing but mostly I just used common sense and tons of working out.

I work out at least 2 hours a day 5-6 days a week for the last 5

years or so, cept when I was really sick with implants. I still

managed to ride my bike when I was sick though, not sure if that was

good or bad but I did it anyway!Now I have cut back a tiny bit but

not much, I still do at least 5 days a week, an hour to 2 hours a day.

Depending on my working schedule and all that stuff.

I also love to dance so when we go out dancing we really work up a

sweat, then we have our hot tub, and that gets me sweaty too.

I think for me sweating was key to my recovery. My neuro stuff was

gone completely within 18 months. Just some foot probs still, and

even those lately have been good. I even wore my heels yesterday all

day, and feel good today.

Things are looking up!

-C

In , " bethlakey " <bethlakey@y...> wrote:

> Hey ,

>

> I'm in Ga and I think they are very cookie-cutter to me, if that

> makes sense. They can't seem to think outside the box. That's why

> when I got sick, I had to find Dr Kolb on my own. Those folks were

> going to let me become disabled, and just sit by and watch I

guess.

> Plus, one of their specialists told me there was nothing physically

> wrong with me. I don't need to be paying top dollar to see people

> like that. At least with a POS that is coming in the Fall, I will

> be able to pick and choose my doctors. The pediatrics in my HMO is

> awesome, can't say that for the adult docs. I have heard the CA

> group is much better.

>

>

>

> > > Oh well, I've been kind of bummed. I got my second denial from

> > > my HMO to reimburse me for surgery. I thought about just

letting

> it

> > > go, and decided I can't do that. For starters, they will cover

> > > complications from cosmetic surgery. And second, they waited

> until

> > > I was almost disabled to give me a referral. And third, I was

> > > insulted by their nasty rheumy. who said there was nothing

> > > physically wrong with me and I should see a psychiatrist. I

> think

> > > that was when I decided to declare war.

> > > Yesterday I contacted my company representative and asked for

> the

> > > Medical Director's name and address, etc. I got a call from the

> > > HMOs corporate headquarters a few hours later wanting to

discuss

> my

> > > appeal. I returned the call this morning, so I guess I'll see

> what

> > > happens.

> > > All I want is reimbursement for the portion they would have

paid

> > > a contracted provider. I don't think that's too much to ask.

> > > Thanks for listening.

> > >

> > > :)Beth

> > >

> > >

> > >

> > >

> > >

> > >

[Guest guest]

Vickie:

Good point. Canada is not the best example. Germany and France is a better example. The UK healthcare system suxs too.My father is British and has private insurance. He told me public healthcare is not very good across the pond.

I've heard Austrailia is good. Don't know much about it though.

LMVickie <gracie17db@...> wrote:

this is just food for thought, but I have a friend who lives in Canada.....free healthcare, right. Her father waited over 3 months to have surgery for prostate cancer due to the hospital being over booked. Free healthcare is not as great as some think. There are problems with our system as well but I wouldnt look for our Congress or Sentate to fix it anytime soon.Jane Doe <oceanlilly_csu@...> wrote:

I'm so sorry Beth. HMOs SUCK! Sorry, but don't some of you here in the US wish we had national health care? Though I've not had money issues in getting to obtain medical care, it sure is frustrating dealing with an insurance company who's goals are to profit. This is in direct opposition to the best interest of the patient--it's fundamentally wrong and immoral in my opinion. I'd rather pay more taxes.

LMbethlakey <bethlakey@...> wrote:

Oh well, I've been kind of bummed. I got my second denial from my HMO to reimburse me for surgery. I thought about just letting it go, and decided I can't do that. For starters, they will cover complications from cosmetic surgery. And second, they waited until I was almost disabled to give me a referral. And third, I was insulted by their nasty rheumy. who said there was nothing physically wrong with me and I should see a psychiatrist. I think that was when I decided to declare war.Yesterday I contacted my company representative and asked for the Medical Director's name and address, etc. I got a call from the HMOs corporate headquarters a few hours later wanting to discuss my appeal. I returned the call this morning, so I guess I'll see what happens.All I want is reimbursement for the portion they would have paid a contracted

provider. I don't think that's too much to ask. Thanks for listening.:)Beth