Aa
MVP
Ok; here I am again stumped at the medical community. I was told by my supplemental health insurance policy that I have been diagnosed & treated for mitral valve prolapse since October 10, 2007.
Here's the thing - I didn't even have health insurance or go to the doctor from March 2007 - April 2009 and I've been told for 5-7 years "nothing" was wrong with me. I had an ekg in 2004 normal even after I complained of CP; SOB; 2007; 2008 normal (a weight loss clinic did the 2007 & 2008 ekg's).
I went through every cardiac test possible since July 2009, and an ablation, cardiac MRI, cardiac catherization, pacemaker/icd implant.
The only thing my cardiologist & ep told me were; I had "trace" mvp even less than in the normal population so HOW the heck can they say I've sought treatment for it?
What on tests do I need to look for to prove I do or don't have mvp? Would one of my ekg's show it?
Here's the thing - I didn't even have health insurance or go to the doctor from March 2007 - April 2009 and I've been told for 5-7 years "nothing" was wrong with me. I had an ekg in 2004 normal even after I complained of CP; SOB; 2007; 2008 normal (a weight loss clinic did the 2007 & 2008 ekg's).
I went through every cardiac test possible since July 2009, and an ablation, cardiac MRI, cardiac catherization, pacemaker/icd implant.
The only thing my cardiologist & ep told me were; I had "trace" mvp even less than in the normal population so HOW the heck can they say I've sought treatment for it?
What on tests do I need to look for to prove I do or don't have mvp? Would one of my ekg's show it?
if I don't hire the attny tomorrow, I'll go to them and ask for a letter
I just don't know what to do next if I don't hire an attny - how do I get the ins co to reveal what 'prior medical history" they based my denial on, I sent in a written request and their response was - we paid for this information we don't have to give it to you.
I'm really torn - hiring an attny is going to be really expensive and he can get his fees paid by them, but his cut is 40% of my settlement ugh and that's normal
I have proof I didn't lie on my app and my medical history is not what they are claiming, but how do I prove that and to who without an attny :(
I just don't know what to do next if I don't hire an attny - how do I get the ins co to reveal what 'prior medical history" they based my denial on, I sent in a written request and their response was - we paid for this information we don't have to give it to you.
I'm really torn - hiring an attny is going to be really expensive and he can get his fees paid by them, but his cut is 40% of my settlement ugh and that's normal
I have proof I didn't lie on my app and my medical history is not what they are claiming, but how do I prove that and to who without an attny :(
Go to the Hospital Administration and ask if the hospital can put anything in writing backing you up on this and give that to the lawyer as well.
I called my last pcp just to make sure I had my facts straight - the last time I saw him was 3/13/2006 and then I called the hospital medical records dept and found out I had no dates of service for 10/10/07 and they aren't sure where Allstate got the records from, but they said not from their office as the letter from Allstate says.
We've used Allstate for alot of our business policies and that's why we got the supplemental health policies, life insurance and critical illness package through them this year.
I think they're bluffing and want me to sign the waiver of payment and that I accept their amendment to my policies and get no payment and just go away.
I set up an appt with an attny for Friday and got all my records and medical history and files in order, I'll let his office handle this it's not worth me getting more upset over.
I'm going to have him look over all my records and see if he thinks anything can be done about my last pcp also.
We've used Allstate for alot of our business policies and that's why we got the supplemental health policies, life insurance and critical illness package through them this year.
I think they're bluffing and want me to sign the waiver of payment and that I accept their amendment to my policies and get no payment and just go away.
I set up an appt with an attny for Friday and got all my records and medical history and files in order, I'll let his office handle this it's not worth me getting more upset over.
I'm going to have him look over all my records and see if he thinks anything can be done about my last pcp also.
Lisa, I've had such good luck with Allstate, it's hard to believe you're in this mess. Tell them that you are planning on contacting the Attorney General's office and see if that makes them budge. Do it if they don't respond to your request. Also go to the hospital and get copies of everything; it's your legal right to have copies, but also understand that they can charge you legally for the copies.
Thanks :) I kind of figured it was something like this. It amazes me that they're allowed to get away with stuff like this - it's not them denying my claim that infuriates me, it's the fact they said I lied - that's something I don't do and even if an attny takes all the $$ I'll hire one just to prove it :-)
If I was treated or sought treatment for something, I would have told them as I put on my application the things I had been treated for.
Looking back at my records 5-7 years I complained of CP and SOB and the dr's told me nothing was wrong - ekg's showed nothing until 2007 during a routine physical, which the dr did nothing about and did not tell me about; I found out from my current pcp.
Would a doctor put his license on the line knowing I had MVP and heart problems to treat me with Phentermine for 6 months? I hope not, that would be a backlash from the medical board (or I think?) and give me concrete proof to sue him.
I think what they did is this - I told my cardiologist & ep; I had CP and SOB for years and Dr. Xyz told me nothing was wrong, the cardiologist & ep put it in their file and then Allstte took it out and are trying to use it to deny coverage and avoid a very large claim.
Even though I had these problems, I had been told nothing was wrong and didn't seek treatment or help for them - and Allstate won't give me copies of their "proof" from a doctor or facility that says I sought treatement from them lol
Check...
If I was treated or sought treatment for something, I would have told them as I put on my application the things I had been treated for.
Looking back at my records 5-7 years I complained of CP and SOB and the dr's told me nothing was wrong - ekg's showed nothing until 2007 during a routine physical, which the dr did nothing about and did not tell me about; I found out from my current pcp.
Would a doctor put his license on the line knowing I had MVP and heart problems to treat me with Phentermine for 6 months? I hope not, that would be a backlash from the medical board (or I think?) and give me concrete proof to sue him.
I think what they did is this - I told my cardiologist & ep; I had CP and SOB for years and Dr. Xyz told me nothing was wrong, the cardiologist & ep put it in their file and then Allstte took it out and are trying to use it to deny coverage and avoid a very large claim.
Even though I had these problems, I had been told nothing was wrong and didn't seek treatment or help for them - and Allstate won't give me copies of their "proof" from a doctor or facility that says I sought treatement from them lol
Check...
Lisa, so sorry you now have more to have to deal with!
As Grendslori says, the Echo is the test results you want, however you are right that a large percentage of the population has been diagnosed with MVP so unless you have significant prolapse or significant regurgitation, it's not usually considered of any significance at all and should not be used as cause to deny you coverage. Also, be aware that in MANY cases you can no longer be denied coverage for "pre-existing" conditions, although that does not stop insurance companies from trying to cut you off anyway.
While it may not be the case here (and I sincerely hope it isn't!), I am unfortunately well aware that some insurance companies will try to "dump", browbeat, snow under with paper work, confuse or otherwise stress "expensive" and/or ill patients in hopes of not paying or underpaying for treatment when they should be -- I have even seen them pull shenanigans like this where suddenly diagnosis are "backdated" in order for them to try to get out of paying for anything "related" that you may have been treated for in the intervening years. The idea is often just to wear you down and out as they assume, and usually rightly so, they have more resources than you do. In some states this is HIGHLY illegal and you may be able to get help. Contacting your State's Attorney General's office is sometimes a good place to start, although laws vary by state.
Grendslori's advice to contact the hospital is good -- if you can enlist their help either directly through the billing department or via the patient advocate/ombudsman if they have one, you can often get farther faster with less stress. Hospitals/medical personnel want to get paid and have plenty of experience dealing with insurance issues. Also, I have seen dedicated doctors help patients as well, although more and more they are leaving this to their own billing departments.
Finally, if you still can't get the help you need, contact your state or federal representatives (either to your state senate or federal senate/house of representatives). Helping people in situations like yours is part of their job and they are often very savvy and good at it. It's also a hot topic right now, so making them aware of what has happened to your with your insurance company could also be helpful to others besides yourself. Good luck!!
As Grendslori says, the Echo is the test results you want, however you are right that a large percentage of the population has been diagnosed with MVP so unless you have significant prolapse or significant regurgitation, it's not usually considered of any significance at all and should not be used as cause to deny you coverage. Also, be aware that in MANY cases you can no longer be denied coverage for "pre-existing" conditions, although that does not stop insurance companies from trying to cut you off anyway.
While it may not be the case here (and I sincerely hope it isn't!), I am unfortunately well aware that some insurance companies will try to "dump", browbeat, snow under with paper work, confuse or otherwise stress "expensive" and/or ill patients in hopes of not paying or underpaying for treatment when they should be -- I have even seen them pull shenanigans like this where suddenly diagnosis are "backdated" in order for them to try to get out of paying for anything "related" that you may have been treated for in the intervening years. The idea is often just to wear you down and out as they assume, and usually rightly so, they have more resources than you do. In some states this is HIGHLY illegal and you may be able to get help. Contacting your State's Attorney General's office is sometimes a good place to start, although laws vary by state.
Grendslori's advice to contact the hospital is good -- if you can enlist their help either directly through the billing department or via the patient advocate/ombudsman if they have one, you can often get farther faster with less stress. Hospitals/medical personnel want to get paid and have plenty of experience dealing with insurance issues. Also, I have seen dedicated doctors help patients as well, although more and more they are leaving this to their own billing departments.
Finally, if you still can't get the help you need, contact your state or federal representatives (either to your state senate or federal senate/house of representatives). Helping people in situations like yours is part of their job and they are often very savvy and good at it. It's also a hot topic right now, so making them aware of what has happened to your with your insurance company could also be helpful to others besides yourself. Good luck!!
Thanks :) I knew someone would have some answers. My first echo was July 2009, so that puts their I've been treated for mvp out the window.
I read my policy and about appeals, but it doesn't go into the appeal process, so I am faxing them a letter telling them I want the specific information they "claim" they have that shows I was treated or told by a dr I had anything wrong with me for them to deny my claim.
Until June 2009 when I broke my toes, I've been told I was as healthy as a horse, that I needed to lose weight, which is why I went to the weight loss clinic - insurance didn't pay for that, I paid out of pocket.
I was under the impression that MVP had to be pretty severe for it to be treated? If I have "trace" mvp that doesn't even require watching, how can they say that I have it?
I can't wait to see what they based my denial on and what doctor I "supposedly" was seen & treated by.
Wonder if there's some info in my hospital files that has been mixed up, or they're basing the denial on assumption because I did complain of SOB & CP in 2004, but the dr did ekg's which showed normal everything.
I read my policy and about appeals, but it doesn't go into the appeal process, so I am faxing them a letter telling them I want the specific information they "claim" they have that shows I was treated or told by a dr I had anything wrong with me for them to deny my claim.
Until June 2009 when I broke my toes, I've been told I was as healthy as a horse, that I needed to lose weight, which is why I went to the weight loss clinic - insurance didn't pay for that, I paid out of pocket.
I was under the impression that MVP had to be pretty severe for it to be treated? If I have "trace" mvp that doesn't even require watching, how can they say that I have it?
I can't wait to see what they based my denial on and what doctor I "supposedly" was seen & treated by.
Wonder if there's some info in my hospital files that has been mixed up, or they're basing the denial on assumption because I did complain of SOB & CP in 2004, but the dr did ekg's which showed normal everything.
An Echo would show the MVP. As far as the insurance goes: what did they say when you told them they could not have insured you during that time frame? Ask them for copies of the insurance paperwork where you signed for the treatment. That's what I would do and then I would go to the facility where this treatment took place and get proof from them that they actually treated you.
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