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Old 12-17-2009, 12:50 AM
LBP LBP is offline
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Join Date: Aug 2005
Posts: 446
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Jack,

I've gained 40-50lbs because my employer provided insurance refused to pay for a necessary back surgery and I had to live 8 years in chronic pain, unable to do any meaningful exercise and daily activities to maintain my prior weight. Just because you're skinny doesn't mean you can't be an alcoholic, drug addict, ridden with various cancers etc! Besides, not all of us have the same metabolism. If you want to address obesity issues, then help keep daily gym classes in school, increase after school sports programs alive, make the school lunch programs more healthy, create incentives with employers or health insurance companies to get a discount for gym memberships.

Stop pointing fingers at the poor and sick. You should be pointing fingers at filthy rich insurance execs and hedge fund managers. They are taking our money without any quality of service in return.

I am exhasted from fighting my insurance company to even address an appeal on a claim. I sent the appeal via certified mail and they have delayed and avoided a decision claiming they cannot find my appeal and yet they will do nothing about the substance of my appeal after repeated calls to remind them I have an appeal outstanding. After months of no progress, I've had medicare file 2 separate complaints because my appeal has been outstanding since the first week of JULY!!!! You can bet that I will never stay with Blue Cross ever again. They are a nightmare. They fraudulently denied PT claims, with an explanation that I exceeded my annual benefits which was patently false becuase I had unlimited PT benefits. What they should have said was that my treater failed to use proper medicare codes. Yet once I convinced my treater of the real problem, the corrected claims were denied as "duplicates" Are you kidding me!!! I am single with one medicare insurance plan. There is no question from the insurance companies prospective that they should have instructed my treater why it was really denied and how to fix the probem, yet they do everything in their power to dely and deny and hope to utterly confuse the problem so that the treaters think the patients owe them money when it's the ins co that owes them money! I can complain to medicare until I am blue in the face but my individual complaints are not likely going to get Blue Cross kicked out of the Medicare Advantage program and there's no fine levied against the insurance company for such disgusting pratices. Where is the accountability for insurance companies? NONE so we need real health care and healthcare insurance reform.

If you can't have meaningful choice of changing insurance plans/insurance companies, or a public option, you are screwed, and if the government doesn't start restricting the costs insurance companies can charge us and regulate with checks and balances for what they can deny, you are doubly screwed.

When I was accepted on Medicare, I had the choice to select Aetna's Medicare plan because that was the only plan likely to cover ADR. ADR is like any new technology, the costs drop over time and it's really not any more costly than fusion.

Even with Medicare based insurance, I cannot believe the jumps in out of pocket costs from last year to this coming year. CT scan copays from 100 to $200. Steroid injecitons the same jump. This year I hit the infamous donut hole re prescriptions by August! But at least my generics were still covered. Next year, I don't even get generics covered once I hit the donut whole. I was paying $90/week in co pays for PT. I've had to not get certain treatments due to prohibitive costs and all it's accomplishing is a delay in returning to the workforce and getting off of Medicare. How is that good for our economy?

Jack I'd like to know what profile of persons you think are the only one's worthy of health care...the one's that don't need it? And who made you God to make such sweeping stereotypical judgments?
__________________
Injured 9/01
Annular tears L4/5 & L5/S1
denied adr by insurance for 2 level charite as well as hybrid fusion at L5/S1 with Charite at L4/5.

New ins paid for 2 level lumbar prodisc surgery on 4/7/08 (at age 39) with Dr. Westerlund, at Core Orthop

Last edited by LBP; 12-17-2009 at 01:16 AM.
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