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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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  #11  
Old 09-10-2009, 09:12 PM
Jack Jack is offline
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Quote:
Originally Posted by Fuzzy View Post
I know of a few people getting fired for blogging internal company information. If the company paid it would be internal information. I am not sure this could be used for a lawsuit. Better oblige if you care about your job.
Yes, I agree. Some states, like the one I live in, do not need to give you a reason to terminate your employ. Unless you have a contract with your employer.
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Suffered thru every non-surgical cure known without relief.
Pain management '06 to April '10,
Had minimally invasive PLIF with internal fixation on 12/28/09 for isthmic spondylolisthesis of L5-S1 (TDR contra-indicated) DDD at L3-4 & L4-5, All L-Spine doing well. Episodes of no pain at all. After being relatively pain free for 4 months, C-Spine gave up. MRI due 11-1
  #12  
Old 09-16-2009, 02:48 AM
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steve55 steve55 is offline
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Default Another dissapointment with a board member here

Once again, a board member who promises to send a copy of his approval letter has chickened out and dissapeared. I wont go so far as to say who it was but at least this person verbally gave me the info so I guess he wanted to help as much as he could without actually giving a copy of the approval letter. Ill give em that. BUt a verbal documentation is no where as strong as having the approval letter. He never told me why but I know why because after telling me he would get me the letter, he said "can they rataliate and ask for their money back? ". Man, its been 3 years since he won his appeal. Come on man, 3 f'n years!! AInt no way in hell that would happen, its paranoiya at its extreme. ALso, it never has happened as per all the back boards I have been on for years now, ...(correct me in Im wrong Harrison, you would know idf anyone knows). No way it is legal, no way in hell it would stand up in court. Approval letters admit they pay due to medical necessity and covered benefit (besides, too obvious it would be based on rataliation if they did ask for money back and would never be held up in court by a judge which is what is needed to collect, and as far as credit goes, the credit bureaus would laugh in their face if they filed a collection once the approval letter is submitted to them) Its no different than a car dealer saying "Oh, I made a mistake when I sold you that car at $10,000, I want to file a motion or file on your credit report to get my money back" . They cant renig after the fact!! And most important, he never signed anything (as no one ever does) that they cant share that information with anyone.

Now, I know Dave C case was different cause his was employee sponsored and he says his emoployer specifically threatned to fire him over it (darn, where is that hidden I phone recorder when you need it, .... that would be a major law suit followed by early retirement if they actually did that!!) However, as in Dave C case, this person hasnt returned my calls, hasnt repsonded to my messages, just ignored me like I dont exist anymore. Nice.

I dont know, Im so sick of people only caring for themselves, I almost dont even want to help anyone else when Im done with mine. That may sound childish, I know, but dam it, when you see everyone not willing to help you, people chickening out cause they only care about numero uno, and you yourself work your as off to put together your own appeals case, it does make you ask yourself "if so many people are only out to cover their own ***, why should I help people when no one helped me"?

Look, if there was even ONE SHRED of evidence or case out there where a insurance company ever came back and asked for the money back based on retaliation, i'd change my tune in a heart beat and would totally not even ask for it as I wouldnt want them to put themself at such great risk. BUt in the , what, 7 year history of people sharing approval letters, there is not one documented , or even reported case where an insurance co asked for money back based on retaliation for sharing an approval letter. It hasnt happened.!!!! Get with it people, it DOESNT HAPPEN!!

Not being able to get this 2nd approval letter could make or break $42,000 because it would mean that Aetna can say "oh we made a mistake on that one case you are talking about".

Im so dissapointed I cant even think straight.Im down right pisssed!!The number of people I have encountered who can help but choose not to out of what I see as completely unfounded fear is unbelievable. Ya know, it will be just as easy for me to turn down sharing my approval letter if I win my case by saying the same lame *** excuse. And I might just do that.

So Harrison, are you having any luck with getting approva lletters? I wont be one dam but surprised if you are not getting any besides the 2 I shared with you so far. People only watch out for themselves and say " screw the next guy, Im watching out for my own ***" . So noble. That's the way this seems to be working. Im sick of it, Ive said my peace, Ive vented, and I wont feel one dam bit guilty if I decide to be less than resposive to people's requests for my help. NOt one bit guilty!!! Im hardened after this experience. After seeing how selfish people are, Im done with it. Ive finsihed my appeal, I worked my *** off for the few approval letters I managed to get.

Im sure alot of people will come on here and act all surprised about my experience and claim they would share their letter if they had one, but ya know, based on my expeience with people, I seriously doubt it. Its all talk, easier said than done. When it comes crunch time, people are chicken **** and care only about their own skin.
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------------------------------
4/08- DDD at C5/6 & C6/7 & bulging discs. C5/6 portrusion.

6/08- Disco results- C6/7 painful, C5/6 popping sounds

7/08- Plasma disc decompression-significant relief obtained

11/08- pain returned to almost pre surgical levels

1/09 -Disco w/ Dr Ziglar shows C5/6 & C6/7 painful-2 level ADR recommended

2/26/09 - c4-c7 ADR Prodisc Nova with Dr Bertagnoli. 100% Success but need C6/7
ADR revision due to subsidence.
  #13  
Old 09-16-2009, 12:31 PM
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Harrison Harrison is offline
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A few people have reported this post to complain (something that rarely happens). I'll leave it open for the moment, but will consider closing it later (when/if I have more time).
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Fell on my ***winter 2003, Canceled fusion April 6 2004
Reborn June 25th, 2004, L5-S1 ADR Charite in Boston
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