Thank-you you all for the kind words. I remembered something else that the HR lady said that bothered me: that my husband is a highly compensated executive, and they have a responsibility to apply the terms of the plan fairly and consistently to all enrollees, and that if they made the exception to approve my appeal it could be viewed as discriminatory, and get them in all kinds of hot water. Wow. I did not know my husband's hard work ethic, being the company's TOP earned Area VP this fiscal year, whose regions alone brought in WAY MORE volume of sales than anyone elses, had anything to do with my surgery and medical appeal. (in other words, your husband made alot of money this year; it was cheaper to go to Germany and you got better care...wasn't that a no-brainer? just pay for it) These self-funded plans have no checks and balances, and make it up as they go along, I believe. She also said they weighed heavily on the HealthPartners Medical Directors' reviews and an external review by an orthopedic surgeon with the Medical Review Institute of America.(anyone know or heard of this review board? Justin?) I recall it was an internist who did the external review, and have requested copies of her documents. She also told me of her elderly mother who had a 3 level fusion a few years back, and is doing just fine. Hmmmm. Now I am being compared to her mother. I told her of the cost analysis I had done (remember my post asking for $$ dollar comparisons from any and everyone?) and she said good thing you went to Germany then and got it done cheaper, and you were going to go anyway to have the surgery performed no matter what, right? (so that means I still should not be compensated for it??) I could go on and on. This was my final appeal available under the company's plan, with my only other recourse being to bring a civil action suit. Yeah, right. Now let's really stir the pot and get my husband fired. He's been with the co. for 16 years, I can't do that to him. Fusion never had to face the strict trials that ADR is facing. When will they get on board?! I had just found another small study that I brought to my appeal as part of my weaponry, doing an analysis of 2 level total disc replacement with Prodisc and comparing it to 1 level cases, and the results were found to be significant improvement for both 1 and 2 level TDR alike, and that they support it as a viable treatment for 2 level DDD. (do the insurance companies and privately owned companies think we are making these studies and compelling results up?) Whew. I've ranted enough. Thanks again everyone. Something good will come from this.
