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LynetteG
02-05-2010, 12:18 PM
My ex recently changed my insurance plan again, this time to Humana, and I found out that although they will cover my back, they are out of network with Dr. Moreno - the only doctor I feel to be good enough to do surgery on me in my area. So I applied to United Healthcare as I'd heard their deductible was only $3,500 and they pay everything else, but today they declined my application due to scoliosis.

So Humana seem to be my only option, however their out of network deductible is $16,000 and then I have to pay 30% up to $28,000, so basically I'd have to pay $42,000 and then anything else the hospital may charge or my doctor may charge me. My doctor's admin called me and said they will talk to Dr. Moreno today and tell him my situation, and see if they can come up with some sort of plan for me.

This is just so upsetting, because with this pre-existing condition of scoliosis, absolutely no insurance company wants to know - so here I am, been told by Dr. Moreno that it's really important to get this surgery otherwise he won't be able to do much correction once it gets over 90 degrees, what the heck do I do? Feel like I'm in a corner and whichever way I turn I'm banging my head against a brick wall, between my ex trying to reduce my income whilst he still has personal trainer twice a week, re-marries and takes his wife on vacations, and then no medical company wants to insure me - aaaggghhhhh!!!

Oh well, I'm sure God has a plan - maybe this is his way of saying - "Lynette, don't have the surgery" :) :)

Thanks for listening to me vent, and if anyone else knows what I can do to get this surgery I'd love to hear it. Remember I've been in the country 13 years, prior to that I was in England and born in Ireland. So I'm not entitled to any medicare type thing I'm pretty sure of that.

God bless to all of you, and hope you are all doing well,

Lynette.

debbei
02-05-2010, 12:53 PM
Regarding UHC's denying you--I'm not sure how it is in your state, but in NJ no insurance company can deny you coverage if you have been continuously insured without a break period.

I'm sorry you're having this trouble on top of everything else.

jrnyc
02-05-2010, 02:42 PM
Hi Lynette
so sorry that you are having these insurance problems...i liked doctors that are not in my network...i get no reimbursement at all...so if i dont go to in network doctors, i dont go! but i found excellent doctors who do take my insurance!! one is even better & more like-able than the others! so it IS do-able!!

WHERE do you live?

jess

LynetteG
02-05-2010, 03:11 PM
Debbei - I live in Florida and if you have a pre-existing condition they don't want anything to do with you - in other words, you're hurting, so what - we don't care is their attitude. I have had continuous medical coverage but part of my divorce agreement was that my ex was supposed to take care of my medical coverage, and he's changed my coverage so many times for one reason or another, I wonder if that's caused a problem.

Jess - thanks for your input also. Unfortunately in my area, Dr. Moreno is the only scoliosis surgeon I would trust to work on me. He has an excellent reputation and I know numerous people who've had surgeries by him and all of them have nothing but great things to say about their experience. Moreno's office is looking at my insurance to see what kind of plan they could possibly come up with for me out of network and they'll call me back probably next week some time. My back is definitely hurting more and more these days, and it really concerns me as I have no coverage for my back even to get pain relief etc. I keep thinking God is challenging me to the absolute hilt right now, don't know how much more I can take to be honest. I am trying so very hard to stay positive and I try to meditate every day now to help balance me and relieve some stress :)

Thanks again to you all for your input.

Lynette.

osumike
02-05-2010, 06:35 PM
Oh man can I relate to this one...Ive been self-employed for about 4 years now, and dont have health insurance. Well, I have been on a discount plan for the last couple years, and Im finding out that it has really been a waste of money. Of coarse I cant get traditional coverage either because of my scoliosis. Ive tried every company I think. So then I called the Ohio Department of Insurance, and they said that every year by law, insurance companies HAVE to accept a certain amount of people on an open enrollment. Its going to cost me about $300-$400 a month, but its well worth it to me. This discount plan Im on is accepted by most places, it uses Beechstreet insurance, but the coverage is terrible. I actually decided that if I dont enroll in this new insurance plan, I would still go ahead with surgery and just be in huge debt the rest of my life. Theres absolutely no way I can continue on being in this much pain.

Hope this helps. I would call the FL dept. of Insurance and ask about this. Good luck.

Shari
02-07-2010, 11:35 PM
This none of my business, but I know for a fact that there are many Dr.'s out there that care about you, your situation and care more about your qualitiy of life than their checkbook.

Try calling different Adult Scoli Surgerons, tell them you situation , and if they can't help you, I'm damn sure they can. Most good caring Dr.s will try to steer you in the right direction. Also most hopsitals have cases that they can write off as a charity case. Believe me there really are Doc's that care about your situation, more than they do the almight dollar!!!

Keep on looking and trying. Just don't give up!!!

Shari

LynetteG
02-08-2010, 05:37 AM
Hi Shari,

Thank you so much. I actually just finished writing an email to Dr. Moreno's office asking him if I could barter my services as a licensed massage therapist, or as a secretary as I have these skills to work for him in exchange for the surgery, once I'm healed of course. The admin in that office also said they would talk to the doctor and call me back this week to see what they could come up with, maybe they will find a way to help me. I'm hoping and praying that will be the case.

Even though I'm not in severe pain like a lot of people here have been prior to surgery - I know that my curve is rapidly increasing - I think it must be increasing 1 degree every two months by seeing from x-rays 18 months ago to now.

Does anyone know how it would affect us if we didn't have surgery? My guess is that I may look very deformed if I didn't get anything done, amazingly, right now I don't look very deformed, my left hip juts out more than the right, and I have a very slight hump on my right upper side of my back, however, I'm sure that would get worse and I'm sure the pain would get worse. I'm noticing the pain is worse quicker now than ever, standing up hurts just after a few minutes, and walking after ten minutes - so I guess I've answered my own questions :)

Anyway, thank you Shari. I have researched scoliosis surgeons in my area, and Dr. Moreno is above and beyond the best here from what I can see.

By the way Shari I definitely would love to hear your story.

Lynette.

ADMoul
02-08-2010, 01:28 PM
Am sitting here at 6 days post-op, looking like something the cat dragged in, but I tell you what, when I walk, even this early, that horrible nervey pain in my leg and hip is gone. Sure, there's a lot of post-op pain but it's different. A year ago, I would have never dreamed of doing this, but denial can only last so long. Had to keep buying bigger bras (not for the front LOL) but because of the increase of the curve. Today, I stood to wash in front of the mirror naked from the waist up and even with post-op swelling, it was like, OMG--I am no longer shaped liked a K as someone on here once described themselves. I know I have many, many weeks/months of recovery and I am praying my Dr. doesn't have to go back in to place the rod he couldn't do because of blood loss. Having this surgery was something I have feared all my life and it was not smooth sailing by any means. Reach down deep, you can do it--am so sorry you don't have the support of your ex, insurance, etc. Maybe the Dr.'s office can work something out for you. Sending you hugs and good thoughts.

JenniferG
02-08-2010, 03:19 PM
Good luck Lynette, I hope Dr. Moreno can help you. I have to say, it was a novel idea offering secretarial services in exchange. There should be more exchange of services, I believe.

Ann, you will love the way clothes look on you now. I too, was a K shape so I know what you mean.

LynetteG
02-08-2010, 03:56 PM
Anne - You are such an inspiration, congratulations on your great recovery and thank you so much for your encouraging words.

JenniferG - Thank you so much also for your encouragement. My best friend is Chief of Audiology at the hospital she works at, and gave me that advice to offer my services in exchange for the surgery, sometimes doctors will agree to it, so I had to try :)

This is such an awesome forum, everyone on here is just fantastic, you are all superheroes as far as I'm concerned. :)

theizzard
02-09-2010, 04:24 AM
This may sound ridiculous but, are there any surgeons in the UK that you would want to do your back? As long as you are still a British citizen you are covered for medical procedures (I think) especially if you still have family over there. Just a thought. Also, I think if you have continuing insurance coverage at least in PA then pre-existing conditions don't count. You have to present a certificate from the ins. company that covered you and if you ask for that certificate they will know what you are talking about.
avis:D

Jimbo
02-09-2010, 05:25 AM
wow, that is one tough situation you are in. I am sorry that this is happening to you on top of the spinal problem.

But I do believe that there will be a way for you to get the surgery, there has to be.

theizzard has a great option you may fall back on, going back to the U.K and get it done under the NHS.

I think it just SUCKS that they wont cover someone for pre-existing conditions in the U.S.

However, with all of my health insurace and medicare here in Australia I am looking at being out of pocket $10,000 right now :(

LynetteG
02-09-2010, 05:38 AM
Avis - It would be impossible for me to go back to the UK to get this procedure done, as I am a single mom of two little boys, I would NEVER EVER leave them that long to go to the UK, plus the fact I'm the only person that can take care of them, their father is pretty negligent with them.

Also in the UK - at least 13 years ago, don't know if it's changed, you have to put your name down on a waiting list to have surgeries if they're not life threatening. My mother's womb was hanging out of her for over a year before they did her hysterectomy, and her brother was a top gynaecologist who tried to hurry it for her!

My previous insurance company - Assurant Health also did not cover my back through their insurance, and then my ex changes my insurance coverage all the time trying to get the cheapest deal he can get, part of our divorce agreement was that he pay medical coverage for me and my sons, which he resents having to cover me. If I had enough money I'd have gone out and got my own insurance a long time ago and stayed steady with it. But he's been paying me less than he agreed to from our divorce agreement for well over a year now and is now officially trying to reduce it through the courts. Does he have less money now? Questionable since he re-married last October and takes her on vacations etc. Anyway, I'm getting off track here, unfortunately, with my medical insurance I have had no coverage for my back for several years now.

I'm also not entitled to disability because I haven't officially worked here in the U.S. to warrant that, when I was married to my ex I did a lot of work for him that wasn't on the books, and then when we had kids my main job was taking care of them as well as helping my ex with his work. So....

Any more suggestions I'm more than happy to hear them. :)

I in the meantime am hoping and praying that Dr. Moreno will come back with something good to tell me - I hope and pray.

Vali
02-09-2010, 06:28 AM
Have you looked into the Florida Spine Institute and see how they can help. It seems that they accept a lot of different insurance and also have interest free terms for other payments. Best wishes.

LynetteG
02-09-2010, 06:53 AM
There is no good scoliosis surgeons in the Florida Spine Institute. My brother had a spinal surgery from one of the doctor's there for just a disc problem, that doctor has left him partially paralyzed around the waist - pity my brother didn't know that prior. I would never go to the Florida Spine Institute just from seeing what my brother has suffered, he later found out when he did find a good surgeon to repair the mess that was left in his back, that he shouldn't even have had surgery in the first place.

So Dr. Moreno is the only doctor that I would trust to do this huge surgery on me, I love my sons more than the air I breathe, and it's so very important for me to come through this well so that I can continue to take care of my little sons.

I've resigned myself to the fact, that obviously I have to have this surgery due to the fact that my curvature is increasing one degree every two months, and if it's going to cost me a fair bit of money then I'll have to try and come up with some kind of payment plan. I've decided if I don't hear from the doc's office by Friday this week, then I'll set up an appointment and just book the surgery with whatever way that I can arrange it, I just hope they can accept some kind of payment plan, or that Humana can set up some kind of payment plan at least. One way or another, time is of the essence for me as I don't want this curve to get over 90 degrees due to the fact that the doc said he wouldn't be able to do much for me if that happens, so that would not be an option.

Thanks again for everybody's input - it's very much appreciated.

Lynette.

Wishing
02-09-2010, 12:49 PM
Lynette, One possible idea. Perhaps you can have your internist or primary care physician write a letter to the case management folks at Humana explaining the need for an experienced, specialized scoliosis surgeon due to the nature, severity as well as the complexity of your condition, and thus it is necessary for you to have an out-of-network surgeon perform this operation and that it important that this surgeon performs a significant number of these complex surgeries on an on-going basis. Insurance companies often give waivers to their restrictions when it is necessary to go out of network to get care, and there is no similarly qualified surgeon in your area. Good Luck.

Pooka1
02-09-2010, 05:49 PM
this elective surgery

:confused:

This surgery was NOT elective for either of my daughters.

Not everyone has a choice.

LindaRacine
02-09-2010, 07:09 PM
Sorry folks, but the discussion got totally out of control, so I deleted all of the offending posts (and probably a few that weren't so offending).

Pooka1
02-09-2010, 07:11 PM
Sorry folks, but the discussion got totally out of control, so I deleted all of the offending posts (and probably a few that weren't so offending).

I KNOW! dhugger was spinning completely out of control! :D:D

LindaRacine
02-09-2010, 07:19 PM
I KNOW! dhugger was spinning completely out of control! :D:D
Very funny... now behave yourself! :-)

Shari
02-09-2010, 08:02 PM
My surgery wasn't exactly elective either. I was told I would be in a wheelchair in 5 years and dead in 10. But they called mine elective, because I decided when and if I had it.

By no means will you EVER find me comparing anyone's surgery with another's.
I guess the smart ass in me made a mistake by using a phrase that may have offended you. That was not intended at all. I was only trying to make a point.

Sorry,
Shari

Pooka1
02-09-2010, 08:07 PM
Smart ass is good.:D

I wasn't offended... just confused. I think some people around here do think these surgeries are all elective and we shouldn't feed their confusion. :)

LynetteG
02-09-2010, 08:46 PM
Hi David,

Yes I've been chatting to Debbie Ordes every day pretty much, we have become fast friends :) - in fact chatted to her today for quite a long time on the phone. I understand that through Humana - Dr. Moreno told me that out of network both he and Dr. Cronen would work on me at St. Joseph's hospital in Tampa which is what I will probably go ahead and try to set up - unfortunately though it will cost me $16,000 deductible, and then 30% up to $28,000 for the surgery, plus any other hospital costs incurred, so that's $42,000. Anyway, at this point I don't care, I'll just have to set up some kind of payment plan and pay as much as I can afford per month probably for the rest of my life, unless I win the powerball :)

But thank you for that info, Debbie raves about Dr. Cronen too, so that's been very encouraging to me.

My little sons both cried in my arms tonight because they are so upset at the thought of me being away from them for a week in the hospital, they've never been away from me for more than one night. I just comforted them and told them if mommy's not upset, then they mustn't be upset, and they can visit me every day :). It's so hard going through a surgery like this when you're a single parent to two wonderful little boys :). Still I'm not the first to do this and certainly not the last. Everyone on here has such brave wonderful stories to relate and are all very inspirational.

Lynette.

LynetteG
02-10-2010, 04:57 AM
David - I didn't realize that Dr. Cronen is under the Humana plan? That is fantastic news - thank you! I completely misunderstood Dr. Moreno when he was explaining that I had to use out of network in order to have him attend the surgery too, I thought he meant Dr. Cronen was out of network too. I'm going to call his office first thing this morning and book an appointment if he's under Humana as Debbie Ordes highly recommends him, and I believe from what you've said and others have said he was trained under Dr. Lenke who is an outstanding surgeon right? So definitely - I'll go see him and see what happens from there.

I totally understand how you feel David, with wondering is this the right time to do it or not! And wondering what would it be like in the future if you don't have it now. That's the reason I'm doing it now, because I know I would be severely deformed and in horrible pain later down the road if I don't get this correction now before it goes over 90 degrees. Do you happen to know how fast your curvatures are growing? From what you say with working with the county etc., it sounds like now would definitely be better for you financially, and also better when you're a little younger rather than a little older to get this type of surgery.

Thanks again for your great info - good luck to you!

Lynette.