ADR denials needs media attention

ans · #1 06-10-2006, 03:47 PM

I'm bummed that I'll need an ADR on several levels perhaps and that my insurance (BC) won't pay. And lots are in the same boat who cannot afford to see Dr. B.

I propose that we have something like this to draw attention to ourselves; maybe having fun would draw attention. For patients who cannot bike, maybe a harness can be attached so really bad-off pts. are in beds - yet pulled.

http://www.worldnakedbikeride.org/

Texas-T · #2 06-10-2006, 06:12 PM

It's hard to believe that insurance companies may decide which treatment's we need... and that they can do this when OUR OWN doctors disagree with them. What if these decisions were life or death? Some of you may argue that they are....

I agree that attention needs to be drawn to this problem, but where do we begin? Maybe we should each write a letter to the same news organization. Describe our problem. ABC has already covered some aspects of the surgery; maybe they would be interested in covering the dirty side of it all?

What other idea's are out there? What about writing letter's to our Senator's or Congressmen? Aren't they supposed to care about these things?

The hardest part of recovering should be physically recovering, not fighting to get treatment!

Harrison · #3 06-11-2006, 06:44 AM

It is time to rally...so many people have urged us on to constructively unite! I'll noodle this seriously; in the meantime, here is one of many good ideas that does not require the removal of clothing, or cycling in the buff:

http://adrsupport.org/eve/forums/a/tpc/f/7701036081/m/4...981037081#2981037081

In the meantime, members -- as you call media outlets or politicians, please share your contact information or strategies with me. I'll reciprocate in any way that's helpful or appropriate!

hucky · #4 06-12-2006, 03:21 AM

Do you have choice of Insurance Companies over there?.

We do, the usual criteria is that if you have a pre existing condition, you have to wait 12 months before they'll cover it.

I've read some of you have been waiting years and I just thought you could have changed to an Insurance Co that does do ADR and wait out the pre existing clause.

Hucky

Texas-T · #5 06-12-2006, 09:29 AM

Hey Hucky,

It's not that simple...
The problem is that in the US Aetna is the ONLY insurance company who pays for the surgery off the bat. In the US your employer picks which plans you can choose from since they bear the brunt of the costs. Unless your employer has Aetna (or even a more favorable ins. company) as an option you can't switch.

Also, if you have a workers compensation claim that is with a seperate insurance company and system.... I don't think you can ever switch companies.... it can be a very messed up system.... this is why people wait and suffer for years.

Once denied you're only recourse is to appeal the insurance companies decision and many people would argue that insurance companies have an unfair advantage in this process. The appeal process takes months.... at least 30 days per appeal and most people have 3 or 4 appeals.

You could quit your job and go to a company who has Aetna as a provider option (I considered this), but if you are so bad off that you need surgery you probably aren't well enough to work and obtain a new job. Also, if you switch companies you lose your disability in most cases.

I was very lucky and was able to switch because of a qualifying event at work. It was so bad though, that my boyfriend and I joked about getting married so that I could obtain coverage under his plan as his spouse if I couldn't get coverage on my own. Welcome to the US health system!

Kim · #6 06-12-2006, 04:53 PM

You are right our healthcare in this country totally stinks! I have been through the mill and I am one of the lucky ones who finally got partial coverage for my procedure. I will be having surgery 6/26.
I do believe after we have talked about this a lot in this forum that there is power in numbers. I wonder if anyone here knows how to do an online petition?
We did that with an animal law that we wanted to get stopped in congress last year on another venue I was working on and it worked between the petition and a lot of people calling their congressman etc.
Why would this not work to show media or whoever we were trying to get the attn of say congress etc to change the laws here that this is not an isolated incident or just a few people suffering?
I think that by showing how many people suffer from this and how wide spread the problem is we would get the attention of someone to help us here.
So if anyone knows how to get an online petition started and is interested in getting this going I think it would help the cause here!

ans · #7 06-12-2006, 07:49 PM

Kim,

I think an online petition if well-written w/citations could be effective. However, I don't know what petition-type is the best. To wit:

http://tinyurl.com/pylsj

Best, Allan

Kim · #8 06-12-2006, 09:45 PM

Hey Alan
Thanks for the link when I get some of my brain cells together hopefully tomorrow I will look these over and see what looks like it would suit our purpose. I think in order for this to be effective we would need to at least tell an abbreviated version of our story dont u? I mean this to me makes it a lot more personal than just signining the thing.
What do you guys think?
Would others here be willing to sign and share on the petition?
Thanks

Texas-T · #9 06-13-2006, 09:38 AM

This may be a touchy subject, but please hear me out....

I think during the inital phase of letter writing etc., it would be best to highlight those who meet the specific criteria outlined by the FDA without exception and are still denied coverage. This way the insurance companies have less ground to stand on. They can't argue that someone who meets the very specific FDA guidelines and has multiple doctors advising them to have the surgery should not have coverage. If we present 1,000 people's cases who have been denied, the insurance companies will focus on the FDA guidelines and I suspect, those who do not meet the requirements for one reason or another. This will deter focus from the 100's of cases who meet the FDA guidelines and are still denied. I think we can present our best case if we initally go about it this way. Everyone suffer's with this problem, but if we can get more ADR's approved for those who meet the requirements, then those who are exceptions in one or more area's will be more likely to be approved as well.

What do you think?

Kim · #10 06-13-2006, 11:44 AM

I agree with this to a certain extent. I also think we need to focus on the fact that several insurance companies are paying for this procedure and that Medicare has not ruled it out for those under 60.
Why should some companies offer this as a valid procedure and others state it is still experimental. FDA is a government entity to tell us that things are safe for us to use in the medical and surgical arena.
Devices have to go through stringent and lengthy processes to get approved by that entity so who are the individual insurance companies to say that once the device is approved they the FDA that they can arbitrailly decide they just dont want to put out the $$$ to pay for it until it suits them.
It really really bothers me that the insurance companies have sooooo much power over our coverage and can even bend appeal processes the way they can.
This opens up a big can of worms for healthcare in this country in more ways than one we are a segment of the problem but its much more widespread than just our situations. I hear every day from other pain sufferers that their ins denied this and such that they needed.
The bottom line is some suit or CEO or beaurocrat should not have the final say so in what our health care and medical care should be.