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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 08-18-2008, 08:42 PM
ERvet ERvet is offline
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Well, folks, at this juncture I have decided to stop the appeals process for the moment. I actually had one of the benefits managers for my hospital's corporate parent tell me: "insurance companies have your best interests at heart...." to which I (politely, but very much to the point) replied, I don't THINK so... Couldn't believe that statement. Anyway, I spoke to the folks at Prodisc, and then to my insurance company (whether they would give me a straight answer or not, it was a very simple question) about continuing to pursue the appeal, or to stop now and reapply at a time when I was perhaps closer to actually having surgery. I am lucky, as my back has settled down to a dull roar more recently, and I am not so annoyed with it. Other injuries are rearing their little heads up, demanding attention, and saying "ooooo, pick me, pick me!!" So I'm going to wait a while, and pursue this more seriously. I'm going to get Laurie Todd's book, and gather ammunition. Probably also going to get one more surgeon's opinion in the next several months. Folks at Prodisc actually seemed like they would be very helpful. When the time comes. So, in the meantime, I will continue to lurk, pop in with comments now and then, try to inject a little humor now and then, assuming nobody minds. Laughter is truly the best medicine. Along with a good NSAID.

Susan/ERvet
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hx of r-sided radicular pain (2003)
5yr+ of chiro, massage, ESI, SI jt injx, PT
2006 L4-5-S1 hemi, no relief
2007-RF @L5-S123, 2mo relief
2008-disco pos @L5-S1, +/-L4-5
Waiting as long as poss for ADR, considering biacuplasty
Don't even ask about the other ortho sx!
New onset left-sided pain Nov 08
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  #12  
Old 08-19-2008, 08:10 AM
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Terry Terry is offline
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Susan:

You are a welcome addition to the forum. I love your humor and, laugh often at what I read from you. Aside from the pain you are in and the trials and tribulations of course. You have a wonderful attitude and, humor is definitely a plus. If we can support you in any way (other than rubbing out the person with the stupid response ), please let us know.

I loved the Blue Ticks Comment.

Hang in there.

Terry Newton
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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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  #13  
Old 08-19-2008, 09:29 AM
chasswen chasswen is offline
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sue
as others have stated if you already started the appeals process then keep going as it will expire and then they win.
chuck
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ddd 1990
2003 mri,xrays,shots,emg
2004 discogram ouch pos l4 l5
facet block neg
lost all appeals BCBS 5 months of that
3 surgeons later
surgery with dr. bertagnoli aug 2nd 2006 in Bogen Germany Successfully ProDisc-L L-4 L-5
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  #14  
Old 08-19-2008, 11:51 AM
ERvet ERvet is offline
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Chuck: Unless I am completely confused, which I do not discount, I'm not certain I have started the "appeals" process.....I requested the surgery, they said no, doctor sent a "but" letter, and they said no. That is all the further it has progressed. I have no intention of dropping everything right now to have surgery, even if they did say yes (those other body parts are screaming much louder right now...). Even Prodisc told me it would be better if I waited until I was ready to actively pursue surgery. I have no intention of letting them win....at this point it is a strategic withdrawal! Gathering more ammunition, recharging my phaser banks, and perfecting my cloaking device. So, I'm still in the game. I come from a long line of stubborn people!!

Susan/ERvet
__________________
hx of r-sided radicular pain (2003)
5yr+ of chiro, massage, ESI, SI jt injx, PT
2006 L4-5-S1 hemi, no relief
2007-RF @L5-S123, 2mo relief
2008-disco pos @L5-S1, +/-L4-5
Waiting as long as poss for ADR, considering biacuplasty
Don't even ask about the other ortho sx!
New onset left-sided pain Nov 08
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  #15  
Old 08-19-2008, 12:09 PM
chasswen chasswen is offline
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Join Date: Apr 2006
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sue
i think you only get 3 appeals and if i remember correct you said you have done 2?
and each appeal has a shorter time frame for replys
just food for thought.
chuck
__________________
ddd 1990
2003 mri,xrays,shots,emg
2004 discogram ouch pos l4 l5
facet block neg
lost all appeals BCBS 5 months of that
3 surgeons later
surgery with dr. bertagnoli aug 2nd 2006 in Bogen Germany Successfully ProDisc-L L-4 L-5
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