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Insurance Hell All insurance-related matters are here: Medicare, worker's compensation, appeals, denials, insights, wins, losses. PRICING is here too. Note: This forum has posts from 2006 forward. Older ones are in the Big File.


View Poll Results: Is this proposed law good for Americans?
Yes 6 33.33%
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Not Sure 2 11.11%
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  #21  
Old 12-25-2009, 11:38 PM
Jack Jack is offline
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Originally Posted by jss View Post
So ADR and the promise that it holds for so many might be granted or denied in favor of fusion by a government bureaucrat based on cost? Rather than selected by a doctor and patient based on what's medically best for the patient?
Or cheaper still narcotics.
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Suffered thru every non-surgical cure known without relief.
Pain management '06 to April '10,
Had minimally invasive PLIF with internal fixation on 12/28/09 for isthmic spondylolisthesis of L5-S1 (TDR contra-indicated) DDD at L3-4 & L4-5, All L-Spine doing well. Episodes of no pain at all. After being relatively pain free for 4 months, C-Spine gave up. MRI due 11-1
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  #22  
Old 01-18-2010, 05:39 AM
kimmers kimmers is offline
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I always believe that everyone is entitled to his or her opinion.

My opinion is that we are in trouble. The fact is the rate of growth of health care spending in the United States is unsustainable. If we do not control health care costs, we will not have any money for anything but health care costs. That means no police, firemen, etc...

We spend more than any other country, and yet our mortality rates are not better. The latest is that the US is spending about 16 percent of its Gross Domestic Product (GDP) on health care. Yet our life expectancy ranks around 50th in the world (wikepedia, et al)

Insurance companies are not in business to keep us healthy. The insurance companies are beholden to their shareholders. Blue Cross, my insurance, keeps raising the money that they demand from my husband and I and decreasing reimbursement rates. Co-pays are increasing also. They cover what they want to cover and mess up on what they pay all the time. I have to call them this week because they must have "forgot" that one of my doctors is in-network.

Our system is seriously broken, and IMHO. the status quo will not suffice any longer.
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  #23  
Old 01-19-2010, 10:18 PM
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jss jss is offline
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... the status quo will not suffice any longer.
Kimmers,

Fortunately no one is promoting keeping the status quo. Democrats have killed every idea that the Republicans have proposed, and Republicans won't vote for the Democrat plans. Hopefully the Republican and Democrat parties will come to good a compromise and give us some good, sustainable reforms.

BTW: ditto, like you, I don't believe that insurance companies are about health care.
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  #24  
Old 01-20-2010, 01:31 PM
kimmers kimmers is offline
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jss,

Hell has not frozen over yet.
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  #25  
Old 01-24-2010, 11:16 PM
LBP LBP is offline
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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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  #26  
Old 01-25-2010, 11:20 AM
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Harrison Harrison is offline
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LBP,

I think everyone here would agree with your points about the frustrations in dealing with insurance companies. IMHO, though, the reforms were messy, ever-changing, and would not have reformed the behaviors that you mentioned.

Case in point: one version of the bill simply REQUIRED 40 million people to become NEW customers for the insurance companies! If you are broke, maybe you can't afford it? Maybe that's why a low-cost option was kicked around!

Any way, I've argued all different sides of this debate, but here's one of my biggest frustrations: where are we as citizens to get all the facts on healthcare reform? It seems like there is no singular, reliable source (or even a few). And this is a problem for all of us who want to take part in the process. There seems to be too much information; too much misinformation! I'd like to see a return to simplicity and efficiency in government...what a dream, eh?
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Fell on my ***winter 2003, Canceled fusion April 6 2004
Reborn June 25th, 2004, L5-S1 ADR Charite in Boston
Founder & moderator of ADRSupport - 2004
Founder Arthroplasty Patient Foundation a 501(c)(3) - 2006
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Donate www.arthropatient.org/about/donate
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  #27  
Old 01-25-2010, 10:28 PM
LBP LBP is offline
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Well here's a no brainer we should all agree on...

send your reps a copy of the FEHB policy that prohibits insurance companies from denying coverage on the ground that a drug or device is "experimental or investigational" after FDA approval. At least so long as it's being used as intended.

I have sent a copy of this federal insurance policy to my congressmen and senators repeatedly. I've asked that this policy become the law of the land for all health insurance policies, whether federal, public or private! IF you want to send a copy, google: "US Office of Personnel Management, Office of Insurance Programs, FEHB Program Carrier Letter, All Carriers, Letter No. 2001-27 dated August 27, 2001."

Harrison re your point of a mandatory insurance reform... that's why the public option should be revived! If you want to require health insurance like car insurance then we need a public option were corp profits is taken out of the picture so the costs go down within the public option, but then helps drive down costs of private plans in order to keep them competitive.

We still need to get rid of pre existing conditions...and make sure that insurers cannot charge 3x the cost if there is a pre existing condition. Making insurance 3x as expensive is really the same as denying somone insurance if that became the republican and blue dog driven "compromise."

Ignore the made up teabag rhetoric of death panels and the like. Right now we have death panels. People are dying because it's a financial loss for insurers to pay claims. Their incentive is not to pay claims. That's a death panel, or a least a cattle prod to long term disability.
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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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  #28  
Old 01-26-2010, 03:58 AM
kimmers kimmers is offline
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LBP I am right with you.

Speak up folks. Or just resign yourself to eventually filling for bankruptcy because that is what health care is going to come to.

What Republican ideas. State co-ops? Come on. Scaring people saying the Democrats wanted Death panels, when they were only really talking about end of life care which is on the agenda and training of every major hospital. It means older people are taken care of with compassion and care in the last years of their life. Insurance companies are the real death panels.

What the health care insurance companies are doing is criminal and they need to be prosecuted.

If someone were to load all the insurance execs on a raft and set them into the ocean where there were hungry sharks swimming about, I wouldn't lose any sleep over that.

My insurance company has contributed to sleepless nights, endless days/nights over a computer writing appeals, stomach upset, my family being super upset, my children crying, my husband worrying about bills and denials, near-bankruptcy due to the skyrocketing medical bills and the denials and lies.

And I continue in severe pain, practically penniless after the health care bills are paid, suffering from high blood pressure and enough stress to blow Mt. St. Helens directly because of my insurance company.

Kimmers
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  #29  
Old 01-26-2010, 05:22 PM
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Harrison Harrison is offline
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I don't disagree with either one of you and I don't think you would disagree with my logic here either. What I definitely could NOT support was the possibility of this outcome (it could still happen, but now less likely):

1. The public option is passed, forcing 30-40,000,000 people to BUY insurance of some "minimal" kind. The policies would likely NOT pay for ADR and many other medical procedures,

and

2. Insurance companies (particularly the Blue Cross companies) would continue with the same policies that we've been lamenting about since 2004 when we started this community.

These are really different problems we are discussing here. I am sorry to say that I don't trust Uncle Sam to solve them both; at least not in the near future.
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"Harrison" - info (at) adrsupport.org
Fell on my ***winter 2003, Canceled fusion April 6 2004
Reborn June 25th, 2004, L5-S1 ADR Charite in Boston
Founder & moderator of ADRSupport - 2004
Founder Arthroplasty Patient Foundation a 501(c)(3) - 2006
Creator & producer, Why Am I Still Sick? - 2012
Donate www.arthropatient.org/about/donate
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  #30  
Old 01-26-2010, 10:54 PM
LBP LBP is offline
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well I have many many more trust issues with big corporate america insurance companies usurping our doctors and making life and death decisions about our heathcare

if it wasn't for my ability to get Medicare, I still would be fighting for my back surgery, assuming I wouldn't have ended my life by now.
__________________
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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affordable health care for america act, bmi, experimental and investigational, fda approved procedure, harry reid, health care, healthcare, healthcare reform, joe lieberman, manager's amendment, obamacare, type ii diabetes

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