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Sharshe
01-30-2008, 11:44 AM
Sorry everyone for being a bug. Has anyone dealt with Aetna or Bluecross Keystone insurance for these operations?

crepehanger
01-30-2008, 12:01 PM
Good luck with Aetna! I don't have them now, but I thought they could be first class turds, on occasion. I hope you get all your issues straightened out, dear!

PNUTTRO
01-30-2008, 12:01 PM
You need to find out what your insurance covers.

Sharshe
01-30-2008, 12:20 PM
specifics...
Aetna is through my workmans comp claim, I hurt my lumbar spine this past Aug. they were doing great, gave me a green light for surgery consultations and any other appt. I would need, then when everything was in place decided I needed a 2nd opinion(even though I had been to another one of their Dr). Now they're telling me I need certain forms filled out that they never sent me and dragging their feet every step of the way, getting them to me.
Keystone is my regular insurance(being used as back up). I have a cap of $3000. per year on co-pays surgery is 100% w/$175 co-pay, and co-pays of $250 per day hospital. But I feel I might need pre-authorization, but when I talk to them they say nothing happens until AFTER W.C. $ is exhausted. So I'm trying to play their games and jump through their hoops, but I am getting tired. My primary says thats what they're trying to do 'til I just give up. I'm afraid I'll get hit with huge bills. :eek:

Sharshe
01-30-2008, 03:22 PM
Just got a letter, they conveniently scheduled my 2nd opinion appt. for 2/19/08. The day after my 1st surgery is scheduled! I'm getting a smidge frustrated now.

txmarinemom
01-30-2008, 04:10 PM
UGH, Sharshe!

It's simply ridiculous how we pay for insurance - and are constantly screwed over.

I hope you can get things straightened out!

Sharshe
01-31-2008, 01:38 PM
Well I had to cancel EVERYTHING! Because they won't change the evaluation date (even though there are open appointments-I checked with the Dr.s 1st :rolleyes:) to before the surgery date. Everything will have to be rescheduled. I now get to call everyone and tell them they've wasted their $ on plane tickets or they can just come for a visit. That would be nice too. But now what will I do for help later? I can't expect people to keep buying tickets!
I now know why people don't like WC. I wanted to just see my Dr when my back went last summer but they wouldn't see me w/o WC because it happened at work. But WC won't free me up to do surgery through my own insurance (this would be for the posterior surgery, they already said they won't cover that). The hold up is over a 5 level lumbar fusion... hope they decide IMMEDIATELY(yeah like that would happen) after evaluation so I can get on with things. The evaluation isn't even being done by a spine specialist! Oh well, I'll just have more time to get ready. Good luck to all you lucky February ladies. Sorry for going on AND on but I'm feeling a bit down right now...

Susie*Bee
01-31-2008, 02:39 PM
Sharshe-- I am so sorry for you! It's bad enough to deal with planning and preparations and emotions for this surgery--and then to have it all fall through is just terrible! Does your WC insurance realize how much they've messed up so many plans? Can your visitors get some kind of medical duress change for their flights? You're sure in my thoughts. I feel so disheartened for you. But I also know you are tough and will get through this too. But still, what a frustrating letdown. Grrrrrr! :mad:

PNUTTRO
02-01-2008, 09:45 AM
So I'm trying to play their games and jump through their hoops, but I am getting tired.

Sorry that you had to cancel--funny, I just did the same thing because I forgot to check my disability insurance before I scheduled surgery.

It sounds like you are doing the right things. Exhausting is a good work to describe it, especially when you are in pain. You probably have had the same people give you different stories each time you call.

If you feel you have suffered a great injury because of your job and you cannot work because of your pain, then you won't get anywhere without a lawyer.

I'll pose some questions, not for you to answer here, but to give you stuff to think about. . .

Is there a reason that you don't want to use the WC's doctor? Did the second opinion doc tell you anything different? Does the first surgeon have a bad reputation or have a history of malpractice? Does the WC want you to do less invasive procedures first--therapy of some sort?

Canceling was probably smart if you had planned to use your HMO. They most likely would not have paid it.

Fusions are usually considered to be elective procedures, because it is a quality of life issue. Some of us put it off for years because of family issues or because we don't want to rush into it.

I hope this helps a little.

Susie*Bee
02-01-2008, 10:35 AM
...Canceling was probably smart if you had planned to use your HMO. They most likely would not have paid it.

Fusions are usually considered to be elective procedures, because it is a quality of life issue. Some of us put it off for years because of family issues or because we don't want to rush into it...

My Blue Cross/Blue Shield-PPO never questioned the need for my surgery. It was covered.

Sharshe
02-01-2008, 10:59 AM
WC just wants to make sure that the 5 level lumbar fusion is really needed because of my work injury not because of living with severe scoli. so long. They just need to clarify so they won't being paying what they don't legally have to. I just wish they had decided all this ages ago! I can't be released to be covered by Blue Cross until WC makes their decision.
BTW, my Dr is very good and has an excellent rep. I was referred to him by the head of ortho and neurology at Thomas Jefferson a VERY good teaching hospital here in Philly. He did explain that the surgery was to stabilize and get me balanced and help with my quality of life (which has gone down a ton over the years, and immensely since I got hurt). Getting straight is just a nice perk :p He specializes in less invasive surgery and adult scoliosis.
One of my problems with the doctor they're sending me to for the 2nd evaluation is he isn't even a spine specialist :confused: But I'll play by the rules like a good girl :D even if I don't want to.
Also found out one of my support team(mom-in-law) was going to have to cancel anyway, her husband broke his ankle very badly the other day and he'll need surgery, so she'll be staying to play nurse for him. There is always a reason for these things...

txmarinemom
02-01-2008, 06:07 PM
Sorry that you had to cancel--funny, I just did the same thing because I forgot to check my disability insurance before I scheduled surgery.

Oh, no! You had to cancel your revision with Hanson?