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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.


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  #1  
Old 07-08-2013, 02:52 PM
twowheelyankee twowheelyankee is offline
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Join Date: Apr 2013
Posts: 28
Default Won my Appeal with BCBS-TX Now TBI Drops BCBS

So after months of dealing with BCBS of Texas, I won my appeal to have a one level lumbar covered. While I was planning on my surgery in the October time frame, I received a letter and a phone call indicating Dr. Guyer (and presumably Texas back Institute) would be dropping BCBS because they don't pay enough. Therefore, I would need to have my surgery before August 1 (When in fact they actually cut ties with BCBS). So all of my post surgery care would now be out of network. I was told I was the second to win a BCBS appeal so how can they be losing money?

I made an appointment with Dr. Guyer for a follow-up consultation and to get some further info. After waiting in the office for 45 minutes without a peep from the staff or doctor, I walked out. TBI does not have a quality staff and the doctors truly do not care about their patients. This might be a general statement, but I have never waited less then 45 minutes for any of my appointments, have to call and email 2 or 3 times to get an answer from the staff.

Through conservative measures I have gotten my back to a point where surgery is not immediately needed, but will be in the future.

Take this with a grain of salt...... May not be reflective of all patients, but it is reflective of my care under Guyer and TBI.

-- Jim
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8 mm A-P herniation with annular tear at L4/L5
Initial Injury 2004
Chiro, 14+ Epidural Injections, PT
ADR insurance appeal won in 2013, delayed surgery
2016 pain is now affecting quality of life. Contemplating ADR surgery again.

2016 delayed surgery again due to successful pain management with meds.
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  #2  
Old 07-08-2013, 07:02 PM
Jerry5 Jerry5 is offline
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Join Date: May 2013
Posts: 363
Default Bcbs

I had Aetna before, and had a choice of BCBS or Aetna, seems now I made a bad Choice.

The Aetna I had before was a HDHP with an HSA.

I am sure that I will have to have a lot of resolve to get this covered by BCBS.

People are dropping them like FLIES.

This is ridiculous, if you have the pain and history, then why not just pay for the ADR.

By the time they hem and haw, make you take a bunch of tests and BS, they will have spent DOUBLE what it would cost for the ADR.

Not to mention that they are causing a bunch of pain.
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  #3  
Old 07-12-2013, 05:39 PM
twowheelyankee twowheelyankee is offline
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Join Date: Apr 2013
Posts: 28
Default that be it

Amen brother!!!!!!!!
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8 mm A-P herniation with annular tear at L4/L5
Initial Injury 2004
Chiro, 14+ Epidural Injections, PT
ADR insurance appeal won in 2013, delayed surgery
2016 pain is now affecting quality of life. Contemplating ADR surgery again.

2016 delayed surgery again due to successful pain management with meds.
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  #4  
Old 07-13-2013, 11:23 PM
Running11 Running11 is offline
Senior Member
 
Join Date: Jan 2013
Posts: 187
Default

I got a one level ADR approved by BC/BS OF OHIO. Although, they paid kicking and screaming. I had to file a first level, second level and at the external level they approved it. I don't know why they didn't approve it .. they only paid 35,000 of 155,000 AND THAT'S WHY PROVIDERS ARE DROPPING THEM. They pay a small protracted fee of the superbill so I don't understand why they put up a big fight. BC/BS are a buch of lying ……. LOL . They are crooked and made billions in profit last year by denying our care!!

Don't give up!
Tammi
__________________
disc bulges C 4-5 and C 5-6
EMG evidence nerve root blockage at C6, C8 and L5
Cogential moderate-severe cervical/lumbar stenosis
Cervical compression with clinical myelopathy with Hoffman's
Tests; MRI's, EMG/NC studies, discogram, CT scan
Pain management; tens unit, ice and heat, physical therapy, chiropratic care, and spinal epidural treatments.
Blue Cross / Blue Shield of Ohio external third party approved Pro-C ADR at C 5-6 on 4/3/13

Last edited by Running11; 07-13-2013 at 11:24 PM. Reason: typo
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