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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%
No 10 55.56%
Not Sure 2 11.11%
Voters: 18. You may not vote on this poll

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  #31  
Old 01-27-2010, 03:53 AM
kimmers kimmers is offline
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Harrison,

Good points.

I do not know how limited the policies would be. Would they cover ADR? Maybe. It is FDA-approved and a public option would have to cover FDA-approved devices and drugs.

That is what logic follows plus the government is looking at evidence-based medicine and the evidence shows that for DDD without contraindications, ADR is indicated over fusion. ADR is superior to fusion in that case. It costs less.
The government in the UK covers ADR.

I don't know how much pared down would be a government policy. I am serious when I say that my insurance sucks. Blue Cross/Anthem has some weird formula to reach the deductible and then the out-of-pocket maximum. I have to meet a $750 deductible for out of network coverage and then it only pays less than 50 percent of the bill and you are stuck with the bill. I paid out of network for my pain doc when i should have been covered in network. Does that make sense?

When you are paying $15-20,000 per year for health care bills and that does not include the price of the insurance, something is wrong. We are paying for service that we don't get. This is like paying $500 per night for two nights at a five-star hotel and you go and find you only get half a day stay for your money. Most businesses do not act or behave like this but insurance companies do.

Even in their so-called evidence TEC assessments and medical policies they purposely omit important studies about ADR and fusion. They don't even keep an even playing field. The cards are stacked against the consumer/patient.

Right now, insurance companies are governed by their shareholders in the market. What is good for the market is what the insurance companies want. Without competition, they can do just about anything they want to and they are. They can push the patient around until most give up. Til some die.

The system is money-driven while it should be patient-physician-driven. No competition equals no change.
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  #32  
Old 01-27-2010, 04:10 PM
JJames JJames is offline
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Unhappy Really, really, really confused!!

I worked from home today as my pain is so bad I really needed a break from the 65 mi (each way) commute to the office at least. I decided between work-related tasks that I would try to find this rumored, two thousand page or so, government health care proposal to begin trying to decide what my feelings or thoughts are on it. I found this forum thread and have read through it ...

Perhaps it's my medication, ignorance, low intelligence, or some mix of all three but I don't know where to begin! I am a registered Independent - not Democrat or Republican. I cannot even blindly follow some political allegiance as I have none. I do not trust ANY politician. Furthermore, I believe that in our great country money is the driving force behind everything. I mean EVERYTHING - and health care is huge money!

The rich are going to ensure that they continue to get richer at whatever cost, and the wealthy are the people who get their peers elected to every government position (not "we the people"!) From what I've gathered, the government's selling point on this "plan" (which as I said is something very vague to me) is that those with no medical insurance need to be provided with it. That certainly sounds nice doesn't it? The rich (who will continue as always to continue to get richer) are most certainly not going to foot the bill, so instead it must be levied upon the ever-shrinking middle class and even the lower (employed) class of people.

My driving reason for attempting to add my thoughts to this thread is that there were several "calls to action", and why aren't people like myself engaging in the fight? I think the answer is that I am not alone in completely not understanding what this government health care really is, what it means (specifically to me), and where to obtain unbiased documentation. I believe that this is no accident or oversight either. Those who have authored this document certainly do not want the "public" to actually know anything!

If by chance anyone could provide a link or some other suggestion for the rest of us to actually have a way to read and review this maybe that would help? That's assuming that the language isn't the secret art of "legalise" which it likely is! I know that the opening post to this thread contained a link to the original document. That's been changed since it was originally posted though, right? If not, I'll go there and start reading ....

Thank you for all your opinions. I have more confidence in the honesty here than I typically do from others. I know we here are all in the same boat to some degree, and that medical insurance has become an enormous factor in all of our lives (really kinda' ridiculous isn't it!).

Thanks again ...
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DDD diagnosed ~99
Chronic Pain since Aug 2006
Failed L4 Microdisctectomy Apr 2007
2008-Positive Disco (L4/L5&L5/S1 annular tears)
Herniated discs at L4/L5/S1, bulging T12
Began constant/severe neck & upper back pain 11/09
Jan 10-Cervical/Thoracic MRI:bone spurs+new disc probs
Cervical Spine issues causing terrible pain beginning in July 2021 - scheduled for 2 level C-Spine ADR on Oct 19th 2021 now!! Part of Clinical Trial so unsure if Mobi-C or Baguera C will be implanted ....
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  #33  
Old 01-29-2010, 09:32 PM
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Harrison Harrison is offline
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Lightbulb Priorities!

While the public option may be a humane measure within a healthier society, I don’t believe it’s sustainable, as:
§ We Americans are a really sick bunch, with appr. 1/3 of us confessing to a chronic condition or illness of some kind. While big pharma profits from this problem, we 100,000,000 people are weighing on the medical system and of course the taxpayers. We as a society need to identify and solve the causes of these problems! I sincerely doubt that it’s soft drinks and Doritos that are causing these chronic issues, though that may be a substantive part of the problem.

§ Until our people and economy get healthier, just “shifting” this patient population onto a new trillion-dollar program is ignoring fundamental, serious and expensive problems. Do we really need to create a whole class of people dependent on another, unsustainable program? Medicare/Medicaid is already in deep trouble. Case in point: some spinal treatment procedures may be affected by 22% cuts in reimbursements to docs by Medicare; we’ll find out after March 1st. Less reimbursement for spine care means less doctors performing the appropriate procedure for the patient.
Before we even get mired in debate about the many unaddressed problems, why not focus on what we discussed as opportunities for REAL solutions that benefit patients:
§ Allow insurance companies to compete across state lines – in any state they can compete – on any grounds. In other words, even if some companies may be more expensive than others, they may offer better, more desirable coverage to subscribers. In other words -- free, open competition. Who are the special interests prohibiting this solution? I'd really like to know!

§ Require that any FDA-approved procedure must be reimbursed by insurance.

§ Prohibit cherry picking of subscribers. Allow people with pre-existing conditions to enter a plan – then help them get better by applying new medical research, insights and even market incentives.
JJ, you’re right – these are complex issues. I think we are blessed and cursed having to look at a number of different sources to piece the puzzle together. In the meantime, thank you all for sharing your ideas here. It helps me a lot too.
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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
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  #34  
Old 01-30-2010, 11:23 PM
LBP LBP is offline
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Default missing the point

I feel like people who post on this website should agree on a base level that the status quo of insurance companies negatively and devastatingly control our lives by refusing to cover our ADR surgery. our experience is much like the documentary SICKO but it's been awhile since SICKO has received a lot of press so we need to remind people of this particular problem. Obama and the Dems are trying really hard to make things better in the heathcare market so let's take advantage of this political time to collectively make our point on at least this one issue.

so, right now it doesn't matter so much what it states on any one bill. There are multiple bills and ideas. There is no final bill yet that is ready to be presented to the President. The House and Senate do not agree and after losing Ted Kenedy's senate seat to a Republican centerfold who says he will join his Republican colleagues and refuse to pass healthcare reform, it's harder for the House to reconcile with the Senate to get a final bill to the President.

The real point is that we all need to contact our House and Senate Reps and tell they what we want and expect them to do whatever it is you expect Put it in your own words. IF you live in a state and district with republicans, tell them you expect them to cooperate with Obama instead of being the party of NO. If you live in a State or district with bluedog Dems, and/or if Ben Nelson, Joe Lieberman, Olympia Snow, Blanche Lincoln are your Senators, you really need to step up and put some pressure on them to cooperate and support the House version of the healthcare reform bill.

For more information about a leading House Rep supporting Health Care Reform, see http://countdowntohealthcare.com/anthonyweiner/ Rep Anthony Weiner is from NY but he has created this website for people who want to support the public option to sign his national petition and/or just read more info about this issue.

Previously, I specifically pointed people in the direction of something concrete. a policy (not law) in place for federal employees with federal health insurance plans. A policy that instructs insurance companies to cover drugs and devices that are FDA approved and to stop trying to call these newly approved drugs and devices 'experimental and investigational.' Why did I specifically point this out...because it's the main reason why most of us were denied ADR surgery! So I feel like this is a point of contention this particular group of people should agree on. And it's something concrete you can ask your representatives to make part of the new healthcare reform.

I feel like the main reason why people like us are failing to making a lot of press noise with our House and Senate Reps is because we are exhausted just from fighting our insurance companies about our individual problems. The way to be most effective is to take advantage of this unique time and make noise. Write, email and call your representatives. Ask your family and friends to do the same. If they see what you've been through, chances are they don't want the same to happen to them!
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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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  #35  
Old 02-01-2010, 08:16 PM
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Harrison Harrison is offline
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Lightbulb

Well said. But a lot of folks here are new and may not be familiar with the content and culture within our community. Accordingly, ANY persons not familiar with OUR fight can read OUR stories here:

True Stories from Patients: Insurance Nightmares Abound

Send the link to reporters, politicians and anyone that can make a difference for us. Also, send me your personal battle with health care in any format and I'll include your story in this topic too!

Members, please vote in the poll too...
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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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  #36  
Old 02-07-2010, 12:18 AM
Jack Jack is offline
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LBP,

I have made my feelings known in other posts on this topic but suffice it to say right now No is the only thing the current supporters of the current healthcare bills understand. Please see my justification for my stance in earlier posts.

And I have notified both my Senate and House elected officials on my views.
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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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  #37  
Old 02-11-2010, 03:01 PM
LBP LBP is offline
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Default Anthem Blue Cross

Proof that the Insurance companies (corp america) are NOT acting in our best interests!!!!!! and need to be reformed NOW

In very recent news: Anthem Blue Cross of CA is raising premiums by 39%


Re: Wellpoint (parent company of Anthem BC)
Just this past January, Wellpoint in the news: they were barred from enrolling new patients in Medicare plans because it denied drugs to elderly insureds endagering their lives. Los Angeles Times Jan 13, 2009 article

In April 2009,
Wellpoint sent out 3 million "robocalls" (automated pre recorded political calls) to round up opposition to healthcare reform, this was their newest anti-health reform corporate strategy see Sacramento Bee, Business section

In Sept 2009
California Attorney General to investigate possible employee abuse by United Healthcare and Wellpoint because they were pressuring their own employees to contact their Representatives in House and Senante in opposition to healthcare reform
see Consumer Watchdog.org Sept 2, 2009

In October 2009
Internal Wellpoint memo cutting its own employee's healthcare benefits
see Bloomberg.com

in October 2009
one of Wellpoint, Anthem Blue Cross subsidiaries sued State of Maine to get the right to raise their premimum rates by 18.5% because Maine's Insurance Superintendent only approved a 10.9% rate increase !!!

Democratic Congressmen Henry Waxman and Bart Stupack launching an investigation into Anthem Blue Cross of California's new 39% rate hike, inviting Wellpoint's CEO to testify before Congress 2/24/10
see Los Angeles Time, business section

and California State Legislator also investigating, a hearing set for 2/23/10

California's Republican Insurance Commissioner, is calling on Blue Cross of CA to delay rate hike until 5/1 while a state-apointed Independent actuary evalutes it.

Dem Senator Barabara Boxer asking CA State Attorney General to investigate Anthem Blue Cross' rate hike

IF you live in CA and have Anthem Blue Cross, NOW is the time to write, telephone, speak up to your congressmen and senators!!!!! Strike while the iron is HOT!

I've been complaining until I am Blue in the face over all the denials from Anthem Blue Cross last year. I was dealing with Wellpoint to get some corrected after complaining to Medicare about them, but they still have failed to address an appeal over durable medical equipment and no one is punishing them for failing to met their deadline to respond to my appeal. I guess it's a good time to call Sen Boxer, Congressman Waxman and Stupak, as well as the State Attorney General and State Government reps!
Those who have the same problems elsewhere need to speak up too!

See the White House Blog by Secretary of Health and Human Services, Kathleen Sebelius, "too many Americans are at the whim of private, for-profit insurance companies who are raking in billions in profits"

also see http://www.futureofcapitalism.com/20...-irks-sebelius says "I was very disturbed to learn through media accounts that Anthem Blue Cross plans to raise premiums for its California customers by as much as 39 percent. ...Your company's strong financial position makes these rate increases even more difficult to understand. As you know, your parent company, WellPoint Incorporated, has seen its profits soar, earning $2.7 billion in the last quarter of 2009 alone."

Thanks to the Rachel Maddow show (yesterday) for summarizing all of this recent news coverage and facts
__________________
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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  #38  
Old 02-15-2010, 12:52 PM
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Harrison Harrison is offline
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Default

LBP, yes indeed. It's a fine mess we are in now. From the recent news, a few points underscoring the conversation in this topic:

A rate hike for the few - until it's you.
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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
Creator & producer, Why Am I Still Sick? - 2012
Donate www.arthropatient.org/about/donate
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  #39  
Old 03-15-2010, 02:13 PM
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Harrison Harrison is offline
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Question For the insurance advocates...

Can anyone provide a link to the latest version of the health care bill (or tome)? I'd like to speed read it...

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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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  #40  
Old 03-19-2010, 10:24 AM
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Harrison Harrison is offline
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Question

I called my congressman's office to inquire about the latest version of the health care bill. I asked if they could refer me to a web site that has the full text document, as the news reports stated it's now online. But where?! Even THEY didn't know where the public could find it! And we have to "wait until it passes" to find out what's in it? What country is this any way?!

Our leaders are asked to read this monstrosity in the next 48 hours to decide their vote. It's 2700 pages! This has turned into a real yikesfest. In the meantime, here's an update from the orthopedic perspective below. Do you think maybe there's a slight chance that the future device tax will trickle down to consumers? And a slight chance that the Medicare cuts will affect all of us? And that a trillion dollar benefit will reduce the deficit? How's that work?



__________________________________________________ __________

House Looks Ahead to a Healthcare Vote
BY LAUREN UZDIENSKI
March 16, 2010

Congress appears to be moving closer to a vote on healthcare reform. While no vote has been scheduled, Speaker Pelosi believes she has the support of House legislators as well as the mechanics in place to pass the legislation. Interestingly, the method by which the Senate's version of the bill will become law will not require a House vote, a process known as "deeming" a bill.


For several weeks, it appeared that the way forward for healthcare reform was for the House was to pass the Senate's healthcare legislation, then passing a series of fixes through budget reconciliation, which would require only a simple majority to pass. However, the House would have to vote for the Senate bill before the reconciliation bill could be passed, which some members were wary to do in an election year, and there were also concerns that the Senate would balk at some of the changes. The alternative is for the House to pass the fixes along with a rule that says the Senate version is "deemed" to have passed - getting around a House vote. Speaker Pelosi seemed confident that Congress would move ahead with this strategy, and she described the bill to the Washington Post as "locked down," with only numbers from the Congressional Budget Office outstanding.

As reform picks up some of the steam it lost in the early part of this year, the device industry is rallying to protect its own interests, namely regarding the $20 billion tax that will support the overhaul. Last week AdvaMed spoke to the press about seeking a cap on the tax, and the lobby, along with the Medical Device Manufacturers Association and the National Venture Capital Association, has followed up with a letter to the White House requesting that the tax not exceed $20 billion over ten years.

Source: See this link.
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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
Creator & producer, Why Am I Still Sick? - 2012
Donate www.arthropatient.org/about/donate
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