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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 09-01-2007, 10:50 AM
Nairek Nairek is offline
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It took 3 months for the fine State of New York to get back to me regarding my appeal against Empire Blue Cross Blue Shield. The decision: they are upholding Empire Blue Cross Blue Shield's decision to deny coverage of the surgery and hospitalization related to the artificial disc replacement. :::sigh::::

I do have other options that I can look into for the ADR other than my sad excuse of a healthpan. I would love to find an attorney who would represent me pro bono in suing them for letting my condition deteriorate. (When taking 2 Hydrocodone for pain does absolutely nothing, then yes something is seriously wrong there).

I have e-mailed Oprah & written a letter to Montel Williams back on August 1st, hoping that they would be interested in doing a show on how screwed up HMO's, PPO's, & EPO's are. I haven't heard back from either of them. If I do, I'll let you know.

In the meantime, it's back to school for me and helping my sister with her wedding in October. I wish those who are still fighting the best of luck. I will be pursing other avenues & hope that one of them brings me some luck.
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----Karin----
Disc Bulge C4/C5, Disc Degeneration T11/T12, Bi-Lateral tears L5/S1, Diagnosed w/ Lumbar Disc Derangement w/ Radiculopaphy. Treatment: IDET, Percutaneous Discectomy, SI Joint Injection, Facet Block. All failed. Empire BC/BS Denied Coverage for ADR-lost all of my appeals. MVP also denied coverage.

ALIF/PLIF Fusion 1/20/09
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Old 09-01-2007, 11:32 AM
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Terry Terry is offline
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Karin:

I am so sorry for your bad news. It is unfortunate that we supposedly have the best health care in the world and it has deteriorated. This in large part due to big business getting involved to suck profit out of people's pain and misery.

Hang in there and God be with you.

Terry Newton
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1980 ruptured L4-L5
1988 ruptured SI-L5
1990 ruptured C5-C6
1994 ruptured C6-C7
1995 Hemi-Laminectomy C5-C6, C6-C7 Mayo Clinic
Bicycle Accident 2004
MRI, EMG, Facet Injections, Epidural Blocks, Lumbar Discogram.
Stenum Hospital Surgery November 4, 2006
Prestige Disc C5-C6, C6-C7
Maverick Disc S1-L5, L4-L5
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  #3  
Old 09-01-2007, 01:03 PM
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Karin,

I am sorry about your health insurance. I am in the same situation. If you need me to join you on Oprah or Montel let me know. In, the meantime, best of luck with your decision.
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Old 09-02-2007, 07:36 AM
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Harrison Harrison is offline
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Sorry Karin...you worked so hard on this appeal. A lawyer contacted me some time ago to see if patients here needed representation; I'll see if he is still interested in helping people like you.
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Fell on my ***winter 2003, Canceled fusion April 6 2004
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Old 09-16-2007, 07:57 PM
Nairek Nairek is offline
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Thank you everyone for your replies. It really has been a long tough road with this appeal. I started my fight last October. I battled them back & forth for almost a year. In the meantime, I'm exploring other options.

I still haven't heard from Oprah or Montel. I don't think that I will either but I figured that it was worth a shot.

Harrison, thank you for looking into the legal representation for me. It may be something to consider in the future.
__________________
----Karin----
Disc Bulge C4/C5, Disc Degeneration T11/T12, Bi-Lateral tears L5/S1, Diagnosed w/ Lumbar Disc Derangement w/ Radiculopaphy. Treatment: IDET, Percutaneous Discectomy, SI Joint Injection, Facet Block. All failed. Empire BC/BS Denied Coverage for ADR-lost all of my appeals. MVP also denied coverage.

ALIF/PLIF Fusion 1/20/09
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  #6  
Old 09-17-2007, 07:39 AM
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Harrison Harrison is offline
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Sure Karin. I also heard from another legal consultant, she's not a lawyer but has 20 years experience in disability and healthcare appeals. I believe she is less expensive than a lawyer too!

I hope you are OK...hang tough!
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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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