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Old 01-25-2010, 12:16 AM
LBP LBP is offline
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Join Date: Aug 2005
Posts: 446
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I am dumbfounded that every single person who is fighting for coverage, or has fought hard for coverage, or those who had to go in to debt to pay for ADR surgery, is not contacting their representatives and doing anything else you can do to support the dems in this fight and help pressure the bluedogs to more progressive reform.

I'm watching dateline discussing a story of a girl who died of cancer because Cigna refused to cover a claim for life prolonging surgery. The CA nurse organization took up her cause, and protested the company in their lobby. Cigna didn't want to look bad with all this press and granted a compassionate exception only to be hours late in saving this girls life. The Ins industry is interviewed saying how most claims are paid right away and denying claims is a "good" way to keep costs down?!?!?!

How dare they make such bald face lies and why aren't you all speaking out. I am so sick of fighting 90% of my claims and no one is taking notice. They lie about the reason why a claim is denied which just confuses my treaters. Ins says I've exceeded benefits which is false. So my treaters send me the bill to pay out of pocket. I'm telling them to fix the billing codes and when they finally do, ins denies it as a "duplicate." It's fraudulent claim processing by my insurance company. Every time I have to make the calls, my blood pressure goes through the roof and then I get horrible headaches and my Mom stresses out because she's worried I'm going to die of a stroke. If I die of a strok, make no mistake, my insurance IS to blame!!! I am so exhausted from fighting.

Most recently, I've been fighting an appeal I made the first week of July re durable medical equipment. They denied the claim, even though I provided them with their own internal documents stating this particular equipment is effective. So I file a timely appeal and send it by certified mail. I follow up multiple times to get the complete runaround. They say they have no record of the appeal. In my book, once I've proved they received it, they are in trouble and have waived their right to deny the claim when the failed to timely respond. Open and shut case right? Oh no... they try to restart the clock after receiving my complaint to Medicare, and yet I can't get Medicare to punish them. WTF. the standard issue csr at Medicare will help me file complaints until I'm blue in the face and sometimes I even get a supervisor. but they refuse to escate it further, even refuse to transfer me to a dept manager or the regional offices. Unbelievable. Medicare outsources some medicare plans to private insurance companies but they won't enforce the rules regulating the appeal procedures, let alone overrule their baseless denials???? And I'm informed that the State dept of Ins doesn't enforce these medicare advantage plans. I'll try a number one medicare rep gave me but I'm 90% sure she was just trying to get me off the phone becuase she didn't know what else to do besides giving me the Secretary of Health and Human Resources contact info. OMG I don't even think we have one appointed to replace the Tom Daschle rescinded appt.

If we don't get reform (democrate style) we might as well not have insurance, just go to the ER and file for bankruptcy every time we get sick because no one in the middle class or lower can afford the cash price of any health care services. Why do we keep making the insurance companies rich with premiums if they just refuse to pay claims, not just the big ones. It's getting worse year by year. Even simple claims like physical therapy STANDARD BLOOD TESTS/LAB WORK, and durable medical equipment are being subject to fraudulent and intentionally misleading delays and denials! They get away with it because no one is there to hold their feet to the fire. It's not worth dying over a stroke to fight them to pay these small claims but what do I do, crawl in a corner, let the pain get out of control and wish myself to die?
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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
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