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The Big File All issues not easily categorized in the above forums are here. Comments on general health, diet, "getting comfortable," and more are here.

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Old 06-26-2007, 07:19 AM
Julaine Julaine is offline
Join Date: May 2005
Posts: 39

It is now to the point where I am just considering paying for it out of pocket. Dr Kropfs office called me and gave me a break down of what it would cost me at century city hospital. The hospital wants 33 Gs, the vascular surgeon wants 2,500. The Physician is 15, and there was some othercost of 5 Gs,. Right now I am in the most excrutiating pain Ive been in, I cannot walk, I havent slept in 6 days. His office yesterday called in a sript of medrol dose pack. which they say should take away some of the pain, but it is not, I think I am getting worse. I cant sit on the dang toilet. If I go to the ER they will say what is what I have heard and others before. My good ness your on how much morphine, percocet and that isnt helping your pain, then they give you some lame shot that they say will send you into lala land once it kicks in, but you still lay there wanting to just die. So now to my question, Did you pay for the surgery and then go after BlueCross for the money. This money is coming out of my daughters college fund. What do I do. I cannot afford this, it is totally ridiculous. I called Blue cross yesterday and they are a bunch of idiots telling me over the phone that I cannot put my appeal over the phone even though the form they send me says I can do it on the phone but I think it is cause they dont want to have to type it all or the internet,but when you go online to appeal it gives you 4 flippin lines to put a whole appeal. Am I suppost to just die here in pain and my kids witness this?
any advice???

Back pain 16 years Chiropractic care 1993-1994DX 2003 DDD at L4 5 S 1January 04-Nov 04 Epi Injections October 04- March 05 Morphine, vicodin, Duragesic, June 05:Blue cross denied my two level ADR
august2005 woke up and had no feeling in legs was in
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Old 06-26-2007, 07:59 AM
Terry's Avatar
Terry Terry is offline
Senior Member
Join Date: Oct 2006
Posts: 1,210

It's a tough decision to make but it sounds like you are not having any kind of quality of life at this point.

I paid for mine out of pocket and did get reimbursed by Blue Cross. I am nervous due to someone else's post here that Blue Cross has one year to get their payment back from you. I had never heard of that. It is unusual that I got reimbursed anyway.

I could not live much longer the way I was living. I could no longer work and my quality of life was such that I prayed to die. I figured I lived a good life and God could take me any time. When it gets that bad your options get more and more limited. They probably inject you with Dilaudid in the ER. It has the tendency to put you in LaLa Land.

I can definitely empathise with you. Ultimately you are going to have to decide. Have you thought of going over to Germany? That is where I went for my surgery. It is definitely cheaper there.

Good Luck and hang in there.

Terry Newton
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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Old 06-26-2007, 11:55 PM
ZorroSF ZorroSF is offline
Senior Member
Join Date: Oct 2006
Posts: 303

I don't think those 4 lines are for an appeal. I think it's for a quick grievance (I have BS of CA and it's practically the same insurance). sort of like when you went to a check up and they refused to pay because they didn't get enough info from your doctor. A formal appeal is many many many pages long and might take you up to two months to write out. It takes a long time to write one and I have hardly started mine.

I'm at the point where I'd rather just bag it all and file a legal notice against the hospital for a multitude of ineptness. A good example comes from Laurie Todd's book with examples of her appeal to her HMO.

I was also wondering about the cost you mentioned. BlueShield and Blue Cross should cover the hospital bill. not the surgeon, vascular surgeon or anesthesiologist. they covered mine and it was somewhere between 60-70 grand. An absurd amount as far as I am concerned.
1/2006 DDD L5/S1

Prodisc St. Mary's 12/2006 not diagnosed properly pre-op and now have DDD L4/L5, facet calcification L5-S1/L4-L5, mild scoliosis and left knee pain. DDD: C3 through C6
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Old 06-30-2007, 12:10 AM
epiphaknee epiphaknee is offline
Junior Member
Join Date: Dec 2005
Posts: 21

I have two comments:

First, the hospital fees seem totally outrageous to me! I know that someone has suggested telling the hospital you are going to Germany, if they can not bring their fees more in line with Germany. It's free to negotiate and to ask for a reduction. They do seem totally egregious to me. What did others do?

Second, and this is out in left field. How about contacting Oprah's show and asking them if they would help you financially in exchange for your/our story: (i) hopes and dreams with insurance companies that suck; (ii) appeal after appeal with insurance, (iii) the procedure itself and all procedures that preceded it - the path to surgery, (iv) the final outcome. Tying it all in with how insurance in the US is not adequate nor does it provide reasonable care. This would be a great show and the story needs to be told!!!
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