insurance company denials

My insurance company denied payment for my consultation with the DR. I am seeing to start vx-950 trial.They only charge for the consultaion then all treatment is provided at no cost. My insurance company Drs. said they could not help me, but also denied me seeing a DR, that could. Thay said I had to bring the specialist and go before teir medical board. My husband explained to them, that if it got to that point it would not be a specialist that would be showing up with us. It would be an ATTORNEY! low and behold , I recieved the approval in the mail within a week. Kalio get tough with your ins. co.

[FlGuy]

Good for you.  I guess persistence pays.  Looks like NYG and I are in a similar boat.  Must pay out of pocket to the the 'rock star' docs.  Although, I didn't challenge my ins. co on the matter. It was a little strange, the doc would not make my appointment until he got a letter of denial from the insurnace co. in advance.  I never saw the insurance folks work so fast to to get me a denial letter.  Good luck.

[Kalio1]

I figure it this way, I am getting my needs met thru Commitmet to Care for now they have me covered for the entire 18 months I am saving my "fight" with the is. co. for when I need it, if this round doesn't work my doc wants to do infergen so I will fight for that. Also my co. changes in Jan. (again) so who knows what will happen. I was so sick ad didn't have the fight in me when this happened so I went with the path of least resistance and Commitment for Care got me meds fast with ZERO copay, the ins. company required the copay plus the few grand paid first. Commitmet to Care has my ins. info, maybe they can squeeze something out of them.

[GrandOak]

Funny how the inference to lawsuit turns things around.  At least it has worked in your favor.  glad to hear it and good luck in your tx.

[NYgirl]

I wouldn't switch off of them if I was you for anything.  They've been marvelous managing your care and with ZERO deducts...what more can you say?

What a wonderful thing it really is.

[jmjm530]

Persistence does pay off. A lot of insurance companies seem to deny most everything initially, figuring I guess a lot of folks will just give up and they'll save money.

For example, my meds are denied 50% of the time, but with one or two follow-up calls from my doctors I have received every med I needed 100% of the time. Talking to a supervisor is always a good place to start with any denial (don't even waste your time with whoever answers the phone)and the first thing I try and find out is what requirements are they looking for in order to get whatever I need approved. Sometimes they don't tell you so I call back and speak to another supervisor until I get one that's not having a bad day.

For example, after my double-Nexium script was turned down twice, a friendly supervisor said that in order to get double-Nexiumn approved, you have to first have tried single nexium unsuccesfully for so many weeks, then to have tried single Nexium with an H-2 inhibitor (like Zantac) for so many weeks, and only then will they allow an rx for double nexium. With that information, my NP practioner was able to get the double Nexium approved with a simple phone call.

-- Jim

[Dale_Ray]

I am starting to believe that insurance people should slither on their bellies like snakes. Deny everything first but cave in to legal threat is their moto. I think we have all had to play that hateful card to simply get them to do what we have already paid them to do. Customer Service has taken on a whole new meaning. Service is something the bull(insurance company) does to the heifer (customer) and I don't believe I want any of that. Glad you guys were able to force their sorry hands. Dale

[NYgirl]

Jim said: Persistence does pay off.

I was turned down for Epogen even with my hgb at 9.0 for some reason but finally after a bunch of phone calls from the doc AND the pharmacist they got it through.

I haven't been turned down for anything sense.

You have to fight for the quality of medical care and attention that you get in this world...that is so true and such an unfortunate lesson that a lot of us have had to learn.

But once you learn it...it changes you for the better.

PS The medical group was notified in writing over a month ago to prepare my charts and things for Dr. J.  I have called three times to verify the authorization went down and everything. My appt is MONDAY and as of today - NO paperwork. The woman now insists she never got it and at MINIMUM it will take her until Wednesday to do it.

Thank GOD I have copies of most of it on my own because I made sure to get them as soon as they came in or I would be going with NOTHING.

I should have been even MORE pro-active than I was (well I DID call the message machine constantly leaving messages so that would have meant I would have had to go down and put my fist in her face I guess) because now I'm screwed.

And what situation would the normal...not obsessively anal about their disease person do? They wouldn't have a thing.

[Mister beagle bailey]

It's a shame but today we all have to fight to get medical coverage.  Glad you and your hubby stuck to your guns and wouldn't take no for an answer.  Much luck and I can't wait to hear what your Dr has to say.

Beagle

[jmjm530]

Make sure you bring your original biopsy SLIDES, not just the report. And don't let them hand you just one. You want the complete set which is usually 4-5. You're paying big bucks to the big man and mine as well get your money's worth. My experience is that they don't charge you xtra to review biopsy slides but of course you could always ask.

-- Jim

[Mister beagle bailey]

Well, I can see you still haven't fixed your home PC.  LOL  I miss you not being on at night.  BTW where is can do mand and fisheress?  

Beagle Bob

[NYgirl]

Unless it's still this hot this weekend....I want to try and finally fix it *but its been too hot!).  I miss talking to you too!

For a few days I was lucky and could get on my home mail at work...but it's petered out again now and I can't connect.

I haven't seen fishy in a while - ditto cando.  I am hoping though that maybe they are posting at night when I am not able to and I'm just missing the lucky stripe!

[NYgirl]

Unless it's still this hot this weekend....I want to try and finally fix it *but its been too hot!).  I miss talking to you too!

For a few days I was lucky and could get on my home mail at work...but it's petered out again now and I can't connect.

I haven't seen fishy in a while - ditto cando.  I am hoping though that maybe they are posting at night when I am not able to and I'm just missing the lucky stripe!

[Mister beagle bailey]

No, haven't seen fish or can do at night.  Hope their well.

Bob

[Pdilly]

Have you guys heard from Doglover28 (pam).   Did I miss something?  She used to be on and I know she was renting a beach house in August and then starting tx.  Have not seen a post for a month from her now.

[sfbaygirl]

I saw her post before I left on the 15th. I think she did go on that vacation. She was really looking forward to it. Was she supposed to get her biopsy in July? My memory for anything (esp. dates) is not good, but I think she was going at the beginning of Aug.

Did you know if you google your screenname it will come up with a bunch of post links to this board? Scary, huh! They used to put dates on the archives, I thought. It helped find things a bit better.

[sfbaygirl]

GO TO PUERTA VALLARTA!  I thought the same thing about feeling bad and going on vacation. It was our anniversary too. I didn't want John to be disapointed when I wasn't up to things there.But we just took it easy and relaxed. It was the best thing I could have done. I did sleep more, go to bed early, had the sx sometimes, but you know what? Not having all those home issues and work stuff and just relaxing is the BEST medicine. I felt better than I do at home in Jamacia. Now the traveling was NOT good. John even arranged handicap wheelchair stuff. I didn't use it. When John got really ill, they thought he was the disabled person!

Laying by the pool and ocean, getting waited on is SO great and needed. Wandering around.... I think everyone on tx needs a vacation like that every few months or less.

[Mister beagle bailey]

Your right, I haven't seen her here in awhile,  Hope  she's alright.

Beagle

[Pdilly]

Nope never knew that.  Learn something every day.  Yes I think she was supposed to have a bx something like the 26th and vacation right after.  Maybe she is just off having a good old time.  She will be glad she did.  I think she is in the vertex trials if I am not mistaken.  I was hoping all that stuff happening after the 4th of july did not scare her off.  
Did you have a great time in Jamaica?   I am thinking about Puerto Villarta in December (right in the middle of our tx).  Its our anniversary.  I hate to miss it but if I am feeling bad I may have to let the vacation go.