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Old 10-12-2006, 08:21 PM
Nairek Nairek is offline
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Join Date: Apr 2005
Posts: 148
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Hi Everyone!

Just thought I would drop in since I’ve been gone for five months. Life just got a little out of control with school and my grandmother was diagnosed with terminal cancer in late May. I made the trip to Germany with my mom to see her one last time. My grandfather answered our prayers and took her home to be with him in early September.

I was suppose to have the Charite ADR surgery on July 12th but canceled it due to my trip to Germany. I also found out three days before I left that Empire BC/BS of NY still considers this surgery to be experimental and they won’t pay for it. Glad I found that out BEFORE the surgery!

I have been fighting with my OS’s secretary to get off her duff and send a letter of medical necessity to BC/BS so that I can get my denial letter and begin the appeals process. I have been trying to light a fire under her tush since April. Still, she hasn’t done it. Her words were “well it takes me hours to create this letter and it’s just a waste of money because they will just deny it anyway”. Well this past Thursday at 3am when I could barely walk, I typed up a nice yet demanding letter to my OS & e-mailed it to him. I also faxed a copy of the letter to his office Thursday afternoon and within 30 minutes, his secretary called me & apologized up & down for being negligent & putting me thru all of this stress. Hopefully she got this letter done today.

I spoke to my employer about my situation a few weeks ago. Her mother has had 2 fusions done so she has an idea what I am going thru. This woman turned around and said to me, “you let me know what I can do to help you”. I was absolutely speechless! Seems she has the gift of gab and the company has a very large contract with BC/BS. Hopefully we can get a positive result out of this.

Well, the hydrocodone & tizanidine are kicking in. Think I’ll call it an early night! Thanks for listening!
__________________
----Karin----
Disc Bulge C4/C5, Disc Degeneration T11/T12, Bi-Lateral tears L5/S1, Diagnosed w/ Lumbar Disc Derangement w/ Radiculopaphy. Treatment: IDET, Percutaneous Discectomy, SI Joint Injection, Facet Block. All failed. Empire BC/BS Denied Coverage for ADR-lost all of my appeals. MVP also denied coverage.

ALIF/PLIF Fusion 1/20/09
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