Insurance denials

[Nellan12]

Hello everyone, I was wondering if there was anyone out there who has had constant denial from the insurance company for surgery,I have spent the past 6 months doing appeals with a state advocate's help and still  only to keep getting denied,In the mean time my condition is getting worse.i dropped my insurance..and went on my husband  who originaly approved the surgery, and now they denied it. I am at a lost ! How could it be that 6 months ago it was ok to have surgery and now they are saying   NO we won't pay !!! Has this happen to anyone else??

[selmaS]

  Congratulations  !!  Do post  your  surgery  date on the surgery  date  thread  so a Prayer thread  will  be posted  on  your  behalf.

[baccalynnwv]

Yay! I was worried about this! Glad you got approved!

[Red_Star]

Great to hear!  An early xmas present. :)

[Nellan12]

Just wanted you to know my surgery got approved by the insurance company  scheduled for it on Dec17, ... It's been a long journey to get to this point, now that I here the nevers are staring to kick in!!!!  :)

[Nellan12]

Maybe ??? I really don't know some people also said that....I did go see an attorney because I have been home for a year so now there is a good chance I will loose my job... But the resin I will loose it is because the insurance my employer has now coast me my job that I have been at for 23 yrs!!!! What a mess!!! The attorney said that basically the law was all in their favor that he felt sorry for me and there was nothing he could do!!  So because I got sick now all our hard work will be drained by doctors ..... Life can be very unfair.. :(

[Red_Star]

A million? *whistle* You could go to the media or create a petition on change (dot) org to bring attention to your case.

[Nellan12]

OMG 10 yrs ago!!!!  Well glad she had her surgery because I just got denied again!!! And yes your rite  even with the insurance paying we ( my husband & I ) would end up with a out of pocket coast of anywhere from $50.000 to $100.000 this is what the estimated coast... The actual surgery I was told is  close to a million dollars and that is why insurance company is really given me a hard time!!!  

[Red_Star]

This happened like 10 years ago lol. It would of cost her $25 000 but she didn't have to pay that as it's under medicare. I have read 62% of bankruptcies in the US are due to high medical bills. O_o

[Nellan12]

Your rite it is all about the money!!!! Peoples lives no longer count !! I hope she gets her operation... Do you know of she has had her surgery yet??? Keep us posted...can you give tell me her name so I can keep her also in my prayers... Everyone  can use a little extra prayer :)

[Red_Star]

Oh well I've just been told I was wrong about that lady's heart operation. Apparently the insurance company wouldn't pay for that heart operation as it wasn't covered. O_o It is was a life saving operation too!  All insurance companies are the same. Money comes first.

[selmaS]

  Hmmmm well   then   I  am   as  confused  as you  are....

  You  can  use  the search this community  feature  to locate  the  thread.....here is  the link  - http://www.medhelp.org/posts/Chiari-Malformation/-List-ur-Surgery-Dates-2014/show/2049539

   I  agree   we   all  can  use  prayers <3

[Nellan12]

Common sense !!!!  that's  all I needed....  as soon as I wrote the post I thought of it. I went into the search bar and found the prayer thread ;)

[Nellan12]

Yes, Dr Bolognese still does surgery thru north shore hospital, so the location  where he will be doing  the surgery has not changed.. And yes they do accept my insurance  because they had approved the surgery before as a secondary insurance... We will see what happens I was told I should get an  by the end of next week....at this point I am so beaten down and tired of these insurance  companies I just. Am letting it go and putting it all in Gods hands.. Thanks ....I didn't know about the "surgery date thread" for Prayer Thread... Where do I look for that I would like to be part of it  also for other  we all need prayers !! Prayers Never is to much <3

[selmaS]

    Ohhhhh...ok....yeah   they  do  take  how long  a  Dr  is  at  a location  as  well  as where ( facility)  the surgery  will take place....so,I kinda  understand....not  only  did  you  change INS  but your  Dr  moved.....

  Do  you  know if  the hospital  he  will be working out  of  now  works  with   your  INS...???

   Do  post  your  surgery  date  in  the Surgery  Date  thread  to  have  a  Prayer  Thread  posted.....

[Nellan12]

Hi Selma S,  6 months ago I had 2 insurance primary and secondary, my insurance from my employment & my husband, back then my Insur. Kept denying  surgery but my husbands always approved it. Now I that I dropped my insurance and went only thru my husband alone as primary they also denied it , but I still have the letter that my husband's insurance company sent me last march approving the surgery..but they said they have the rite to deny it because my doctor Dr B  as you know left the hospital and is now working in a new practice, but if he was still at North shore they said the approval would still be valid.... Makes no sense.. Surgical nurse said Dr B will appeal it and surgery is still scheduled for Nov. 4th we will see?? It would be the first time surgery got cancelled the night before,last time I got a call 13 hrs before my surgery to let me know that insur. Denied it  sorry for going on & on...
Thanks for always being there Selma your such a good person <3  

[Nellan12]

You are very lucky that you don't need to pay for your insurance, here in the US we have to pay for ours and then when we need it they either approve  it or deny, they hold your life in theirs hands!!! It makes no sence!  

[selmaS]

  Yes, I  do  know...all  surgery  can do is help  with  some  symptoms  .....sad that the INS  comp is  being so  difficult....but they  do  not want to  pay....

  Another thing...you  said  6  months  ago....most   INS  comps   make  you  wait  a  yr  for  pre existing conditions when you  switch coverage....not sure if that  still applies....but  look  into that.

I lost  my  job even with  having surgery....I  was  out too long...crazy...but we are  making it....I only  have  one child who  was  in grad  school  when  I  had  surgery....so all her own  bills   to pay....if I  was  working I would  be helping  her tho....there  are things we  can  do, and  some  we  can  not......

[Red_Star]

I live in Australia where insurance is optional as every citizen is covered under medicare.  But I haven't heard of anyone being turned down for surgery who pay for optional insurance. That said, one lady I know was paying for the highest insurance coverage but when she needed immediate open heart surgery she was sent to the public hospital. :)

[Nellan12]

Hi Selma well as you know with CCI you can never get better also in my MRI  Dr B saw that my C1  is under the C2.. but it is also in reverse, so the tip of the bone is in my throat,that is why I often choke..but also back in march Dr B did the traction test at the hospital,and when he had 35 lbs of heights on my neck I had a tremendous amount of relief, the pressure inside my head,my vision,was so much better, I was shocked never did I feel that way,( of course I was born this way so I don't know what it means to feel good,I just want that feeling back ! ) I just don't understand how insurances can find all kind of excuses and have the rite to hold my life in their hands, we have 3 kids at home 2 college tuitions and a junior in high school ,and in the mean time my finances are getting so difficult, draining our savings, I have been out of work for almost a year and now next month I can loose my job after 23 yr because the Ins.won't let me have this surgery.  ????

[selmaS]

  Hi....so sorry  they are  putting you  thru this.....


  May  I  ask....what  reason  other then  symptoms was given for surgery...what symptoms do you  have  and  which  related conditions  do you  have?

  I ask  all of  those  since  it  is  what most INS companies  look  at...and  the INS  comp of  your  DH  may   be  refusing  since they know another  INS  comp had....no other reason....sigh...

Get   as  many  related conditions DX'd  and  confirmed,.,...this should  help...as well  as  documented  symptoms....ie- drop  attacks...easy  to show when  injuries are  incurred....

  Hope this helps some....keep us  posted.