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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 09-16-2011, 10:27 PM
gymnast1981 gymnast1981 is offline
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Default Patient Assistant Line (PAL) & Advocate

Has anyone used PAL or an advocate to help with their appeal?
And has anyone had success?

Ive tried to look at past threads on here but couldn't find anything.

My neurosurgeon has set me up with the Patient Assistance Line (PAL) who helped me get an advocate (Lindstrom) to help with my appeal/denial.

Once UHC denied my claim, PAL started gathering info for the appeal right away, we had to wait over a month for UHC to fax over the denial letter, they kept claiming that they faxed it, but nothing was ever received, then they claimed that it was never generated.... a bunch of lies!

On Tuesday (night) September 6, 2011 I received a UPS package that was left on my doorstep regarding the appeal. it was all my medical records, doctors notes and other insurance things... THEY LEFT IT BY MY FRONT DOOR UNDER A MAT! I mean come on! I have had to sign for things that you wonder why do I have to sign for this, and something that has personal info in it is just left on the front door for the whole neighborhood to see and possibly take!

I WAS PISSED TO SAY THE LEAST!

The package we got on Tuesday night stated that there would be a conference call that next monday (September 12, 2011) So I had 5 days to figure out what I wanted to say or do, and if I wanted to be apart of it I had to call in and give them my phone number. Thankfully I had Lindstrom Advocacy helping me out. I thought that the call went pretty good but I guess it didn't because they sent a letter either that day or the next day that the decision was being upheld.

So Im thinking they didn't even listen to what I had to say or what Lindstrom had to say and just kept the decision of the previous decision. It seems like to me that they left the call and all said "denied" "yep, yep, yep" and then that was it, they didn't put any thought into it. But what do i know I'm only the one LIVING IN PAIN, and the one that is trying to maintain my active lifestyle.

We found out later that the "expect" that made the decision graduated from medical school in 1961, and he's a pediatrician.

sorry for the long post I am just so frustrated (like everyone else that is on here dealing with the evil insurance company)
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Becky (30 yrs old) From Wisconsin.
2004 my back goes out for the first time.
MRI in 2004, 2009 & 2011 DDD L4-L5.
MRI in 2011 more DDD and disc starting to bulge.
Fought UHC for 8 months and WON
October 31, 2011 IRO overturned UHC denial!
November 22, 2011 my spine got an upgrade.
(ProDisc-L) Best medical decision I have ever made


http://www.facebook.com/rebeccabille
my story: http://youtu.be/hT1jKmcOV8Y
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  #2  
Old 09-18-2011, 12:46 PM
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Harrison Harrison is offline
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Becky, you have every reason to be upset -- there are so many absurdities in your situation. Is PAL a company or a division of a company? Keep fighting. If you can hire a lawyer, that will help...if you can afford it.
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  #3  
Old 09-18-2011, 03:38 PM
gymnast1981 gymnast1981 is offline
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If I understood it correctly... PAL is a part of Synthes (Pro Disc-L) My doctor's office knew that UHC would deny the claim, so they started the process with PAL as soon as I decided that I wanted to have the surgery. We got all the info together to get ready to fight the appeal. (denial was upheld so we are starting with an independent reviewer to make the final decision). Again if I understand it correctly Synthes (Pro Disc) has a hotline to help patients get the procedure covered. I look at it as its considered "new" and "un proven" so if Synthes can help people that need the procedure then they get paid so it benefits them and the patient. (but then again I'm not exactly sure)

Since I wanted to have ADR I wanted to get the process rolling and a few days after my doctor filed his surgery orders to UHC all my info was sent to PAL and with in a day or two a representative called me to get my approval to have PAL represent me. They have been nothing but great. I work with Amy from PAL and I shoot her an email and by the end of the day she gets back to me, even if it "I'm not sure but ill get back to you asap."

PAL gets the info ready to go towards the advocacy (in my case it is LindstromAdvocy) I did some research on him and his company and he graduated from law school and advocates for people that are fighting insurance companies to cover procedures that are considered "experimental' or "unproven"

here is the link that I found that gives more of a description on what PAL is and how it works

http://www.synthes.com/MediaBin/US%2...cC-LJ8699B.pdf
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Becky (30 yrs old) From Wisconsin.
2004 my back goes out for the first time.
MRI in 2004, 2009 & 2011 DDD L4-L5.
MRI in 2011 more DDD and disc starting to bulge.
Fought UHC for 8 months and WON
October 31, 2011 IRO overturned UHC denial!
November 22, 2011 my spine got an upgrade.
(ProDisc-L) Best medical decision I have ever made


http://www.facebook.com/rebeccabille
my story: http://youtu.be/hT1jKmcOV8Y
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  #4  
Old 09-18-2011, 06:12 PM
annapurna annapurna is offline
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Mary Jane Stull, The Patient's Advocate fighting the Insurance Nightmare and Providing Medical Claims Assistance., has helped Laura and I with a number of items; not ADR but other spine procedures and knees, SI, and other areas. We didn't head down the appeal route with those but she was able to drag money out for procedures that we'd never have been paid for otherwise. She is, though, expensive if you need to pay her by the hour.
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Laura - L5S1 Charitee
C5/6 and 6/7 Prodisc C
Facet problems L4-S1
Knee, Shoulder, Toe, Finger, Elbow Problems

Jim - no spine problem but lots of other fun medical challenges

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  #5  
Old 09-19-2011, 07:12 PM
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laid up doc laid up doc is offline
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gymnast - do you qualify for a clinical trial? i would think that's your best bet if you don't have any litigation involved and are willing to be in a trial.
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US non-spine MD - laid up no more!!!
had recurrent annular tear L5/S1, failed everything
M6L done 10/19/11 w/ Dr Clavel getting back to my old self more and more every week!
laidupdoc@gmail.com if my PM box is full

The content herein represents my professional thought and opinions in a general sense only; they do not constitute professional advice or services. if you need medical advice, please consult a licensed physician.
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  #6  
Old 09-19-2011, 10:27 PM
gymnast1981 gymnast1981 is offline
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i haven't looked into a clinical trial but if i get denied again I'm going to have to do something so ill look into it. but i wouldn't even know where to start looking for that.

i just know that I'm in chronic pain daily and its just getting worse. the pain is stopping me from doing a lot of the stuff i want to do, like spot my gymnasts and or just function as a normal human being :P
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Becky (30 yrs old) From Wisconsin.
2004 my back goes out for the first time.
MRI in 2004, 2009 & 2011 DDD L4-L5.
MRI in 2011 more DDD and disc starting to bulge.
Fought UHC for 8 months and WON
October 31, 2011 IRO overturned UHC denial!
November 22, 2011 my spine got an upgrade.
(ProDisc-L) Best medical decision I have ever made


http://www.facebook.com/rebeccabille
my story: http://youtu.be/hT1jKmcOV8Y
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  #7  
Old 09-19-2011, 11:55 PM
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laid up doc laid up doc is offline
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found this via google... for freedom trial Freedom Lumbar Disc in the Treatment of Lumbar Degenerative Disc Disease - Full Text View - ClinicalTrials.gov
__________________
US non-spine MD - laid up no more!!!
had recurrent annular tear L5/S1, failed everything
M6L done 10/19/11 w/ Dr Clavel getting back to my old self more and more every week!
laidupdoc@gmail.com if my PM box is full

The content herein represents my professional thought and opinions in a general sense only; they do not constitute professional advice or services. if you need medical advice, please consult a licensed physician.
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  #8  
Old 09-20-2011, 12:32 PM
gymnast1981 gymnast1981 is offline
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Doc,
I looked into it and my husband requested info and they emailed him back with in minutes to tell him that the trial is full and they are not accepting anymore patients
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Becky (30 yrs old) From Wisconsin.
2004 my back goes out for the first time.
MRI in 2004, 2009 & 2011 DDD L4-L5.
MRI in 2011 more DDD and disc starting to bulge.
Fought UHC for 8 months and WON
October 31, 2011 IRO overturned UHC denial!
November 22, 2011 my spine got an upgrade.
(ProDisc-L) Best medical decision I have ever made


http://www.facebook.com/rebeccabille
my story: http://youtu.be/hT1jKmcOV8Y
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  #9  
Old 09-20-2011, 01:11 PM
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laid up doc laid up doc is offline
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i know they are at Carolinas Neurosurgery and Spine - Dr Coric - if you can travel. others may still be recruiting too... but again, would involve travel. you MAY be able to arrange to do some of your follow-up locally if it's the same study just a different site. Dr Coric I know has a dedicated research nurse. they tried to recruit me, i didn't qualify b/c of pending legal issue mainly.
__________________
US non-spine MD - laid up no more!!!
had recurrent annular tear L5/S1, failed everything
M6L done 10/19/11 w/ Dr Clavel getting back to my old self more and more every week!
laidupdoc@gmail.com if my PM box is full

The content herein represents my professional thought and opinions in a general sense only; they do not constitute professional advice or services. if you need medical advice, please consult a licensed physician.
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  #10  
Old 09-20-2011, 02:46 PM
gymnast1981 gymnast1981 is offline
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Join Date: Sep 2011
Posts: 150
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ill look into that. i really want to get this done if i can. im so ready for it
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Becky (30 yrs old) From Wisconsin.
2004 my back goes out for the first time.
MRI in 2004, 2009 & 2011 DDD L4-L5.
MRI in 2011 more DDD and disc starting to bulge.
Fought UHC for 8 months and WON
October 31, 2011 IRO overturned UHC denial!
November 22, 2011 my spine got an upgrade.
(ProDisc-L) Best medical decision I have ever made


http://www.facebook.com/rebeccabille
my story: http://youtu.be/hT1jKmcOV8Y
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