RE my WC. UR has once already denied me this surgery so a decision has been rendered and handed down once already. The WC company tho at the time was willing to pay for the surgery. New heads are there now and a clean up of cases is going on so my case being and old one with Lifetime Future Medical (since '82) was one where the new Claims Head (not sure of exact title) said that this surgery was no longer being offered for me. However, she went on to say that if the request for multilevel ADR was put on the table again, UR would once again deny it and so that would be my final answer.
I don't have an attorney any longer. I have had Lifetime Future Medical Benefits since the early 80's. As long as WC isn't denying treatment all together, likely they aren't going to be found to be doing anything wrong.. there is the appeals process I can go thru when UR renders a denial of services..
Right now I'm not asking for anything as I need to get some documentation on something that I'll be asking if any of you can assist me with (in a seperate post).
Today I called Medicare and there'd be no problem w/having the BCBS insurance (of Mass. tho we live in CA. - it's just what the company is carrying) altho I was advised strongly to check out Medicare's new prescription drug coverage plans to make sure that the BCBS plan would be comparable or better.
Now on to BCBS. I have to call and ask to speak to a Benefit's Specialist. On the website for BCBS with the list of exclusions, WC related medical concerns is there.
Sometimes insurances do weird things tho and do cover what they say they don't or won't cover and vice versa so it's worth checking out ..I've found in the past information varies depending on whom you speak w/and often how well something is understood by the person giving the information (and then how much might actually be told to you or how much someone really wants to assist you)..and then some other turns of events...
One of the things in general I have concerns about is regarding the co pays, out of pocket deductibles and so forth as now that I've moved, I don't want to get into $ hassles w/spouse regarding this kind of thing..
If I do choose this coverage, and I ever want to go back on AARP (Medicare Supplement) I have to lose coverage from BCBS, it cannot be a voluntary choice to get back on it just in case there are some probs with how my spouse and I handle the policy coverage costs while we are living apart ...
sigh.. things like this make my stomach hurt..
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