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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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  #21  
Old 11-03-2011, 10:55 AM
gymnast1981 gymnast1981 is offline
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Join Date: Sep 2011
Posts: 150
Default

I guess my next step is to schedule the surgery. Once I opened the mail and got the letter yesterday... I kind of jumped up and down for a while screaming :P and then called the doctor but it was almost 5pm when I called so now its another wait to hear back from his office to get in and schedule the surgery!

I have been waiting for this for almost 8 years!

Im terrified and yet extremely excited to finally getting this done!
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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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  #22  
Old 01-06-2012, 07:14 PM
gymnast1981 gymnast1981 is offline
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Join Date: Sep 2011
Posts: 150
Default UCH can suck it

Ok so my surgery was approved November 1 and I had my surgery November 22

we fought with UHC lost and then fought again and lost the appeal then an IRO got brought in and made the final decision and it was approved November 1

well now UHC is trying to screw with me (excuse my language) but they are trying to deny the surgeons that worked on my case. I had 2 surgeons a general surgeon and my neurosurgeon and apparently UHC has decided that they will and have paid for all expenses for ADR but won't pay the doctors.

anyone else have this issue?
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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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  #23  
Old 01-06-2012, 09:15 PM
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Harrison Harrison is offline
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Join Date: Oct 2004
Posts: 7,010
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Becky, this is absurd -- but somehow not surprising. I am so sorry. I have seen every flavor of rejection from insurance companies since my own in 2004, so nothing would surprise me. Keep fighting or get a lawyer, or both. They expect that you will give up. They are preying on your weakness.

I hope I can turn this into a positive -- I'll say a prayer for you tonight. Turn "preying" into "praying" so to speak. Who is the patron saint of insurance appeals?!
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  #24  
Old 01-06-2012, 09:59 PM
gymnast1981 gymnast1981 is offline
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Join Date: Sep 2011
Posts: 150
Default Harrison

Oh i have lawyers on my behalf (PAL set me up with Lindstrom advocacy) his group is an advocate on medical procedures... so from the very beginning i have had lawyers doing the appeal process for me.

all i have had to do through the whole process is sign papers and such. Lindstrom's team put together the appeals and did all the leg work. and i have been told by PAL that I have nothing to worry about because the ADR was approved and i will not owe anything no matter what and if it comes to it Lindstrom will get involved again and fight it. but to my knowledge ( but then again who knows if I'm right ) but this is all between the doctors offices and UHC but again it could all be a mix up and someone that didn't know it was approved sent out the message.

but i do appreciate the prayer. ill take anything I can get!
__________________
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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  #25  
Old 01-08-2012, 07:26 PM
gymnast1981 gymnast1981 is offline
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Join Date: Sep 2011
Posts: 150
Default so someone explain this to me

so I've been looking into the reason why they denied my claim after an IRO overturned the claim and approved it, UHC PAID for Anesthesia, Hospital stay, Radiology but they won't pay for the surgeons... um what the heck!

on my online benefit explanations of claims paid the two things that are not paid are both surgeons so to me I could have the procedure but I couldn't have the two people who know what they are doing put it in? does this sound strange to anyone else?

here is what they state for why they are denying to pay the surgeons...
we went through this and it was approved so I'm really confused.

ANYONE ELSE HAVE THIS ISSUE?




*Remark Code PE: Based On The Information Provided, This Service Is Unproven And Is Not Covered. Therefore, No Benefits Are Payable For This Expense. In Order For This Service To Be Considered For Coverage, Scientific Evidence Must Be Submitted, That Meets The Standards Described In Your Benefit Plan Language, That Demonstrates The Safety And Effectiveness Of This Service For Your Particular Condition. If The Service Was Received From A Participating Provider, The Provider May Not Balance Bill For The Service Unless The Member Has Given Pre-service Written Consent To The Ordering Or Rendering Provider To Be Billed.
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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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