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pilar
08-04-2009, 01:15 PM
well my friends,
at this point I don't know if I will get the procedures done. My year max for my insurance is 50,000 dollars, and it will not cover all the surgery expenses. My Dr. is afraid that he will not get paid and his assistant call me today saying that he will do it if I pay out of pocket 18,000 dollars for his service. I understand this is a huge compromise he is making, but I am a student and I have a minimum pay part-time job, so I don't have that kind of money, not even 10% of that... I get my insurance through school, so I should have know better...
I don;t know what to do. I guess there is nothing I can do at this point. If any of one know about medical grants or something like that, please any information will be appreciated.
Pilar:(

Qikdraw
08-04-2009, 01:34 PM
I donno what to tell ya. If you're in Los Angeles like your location says, well Arnie just line item cut a LOT of healthcare spending for people in need. I do not know about any federal stuff either.

I don't know if you are religious or not, but you could go to some churches in your area and see if they can spread the word and get you some help. When I was operated on my family had to pay about $60,000 (roughly) and churches from all over donated to help out. It was amazing how far donations were coming from, it was a real blessing.

So you might try that avenue, even if you're not overly religious a church may know of some agencies that may help out too.

leahdragonfly
08-04-2009, 02:58 PM
Hi Pilar,

I am so sorry to hear your news. The $50,000/year limit would preclude many major surgeries. I am wondering if there is a way to appeal to the company, to get a necessary surgery authorized. I can't imagine the insurance company could justify denying a surgery such as this. Heart surgery of any kind would be well over $50,000--so do they just get to tell all their pt's "oh,sorry"???

I would recommend calling the insurancve company and try to speak to a customer service manager, and explain your situation. Inquire about the appeals process.

If that does not help, you may be able to contact a free state insurance ombudsman, someone who can help advocate your case for you.

I wish you the very best of luck, and please, let us know how things are going for you.

rzbud
08-04-2009, 03:29 PM
Pilar,
I am so sorry to hear about this situation. This must be a real disappointment for you. I can't even imagine having to go thru all the research of doctors and getting your mind set to have this happen.

I hope there is a turn for the better for you and that someway, somehow
something will come your way. My prayers are out for you.

Rzbud

Doodles
08-04-2009, 05:38 PM
This is horrible that they did this to you. I would suggest writing to your Congressperson--especially someone who is trying to push the healthcare plan. Send copies of X-rays with it. Most of our x-rays really get folks attention. I'd call too. You never know; it might be worth the effort. I just heard of one they talked about on cable channel today. They "straightened out" with insurance company so a young man could get a surgery he needed. They had originally denied it. Best of luck to you. Janet

twistedmama81
08-04-2009, 07:27 PM
God what an awful thing to do, SOOO close to your surgery! I can't even imagine, and I am so sorry you're dealing with this. The others before me have posted great suggestions so I would definitely try that out, and if you need some people to petition for you, well WE GOT YOUR BACK! :) I will call whoever, if thats what it takes...I pray you get this take care of in your favor.

jrnyc
08-05-2009, 01:26 AM
Hi Pilar
i know this may sound strange, but sometimes it helps to contact your congressman(woman)...at times they are aware of resources & people who might be willing to help...it wouldnt hurt to call their office & tell the staff that you are a constituent that needs help....or you could have your parent call....

best of luck to you
jess

JenniferG
08-05-2009, 03:36 AM
That's horrible, Pilar. I can only hope that someone is able to help you. It just doesn't sound fair. Good luck!

Vali
08-05-2009, 06:50 AM
Hi Pilar,
As I'm from Australia and don't know much about the USA health system, is it possible for the insurance company to max out this years $50,000 and half of next years max just for this surgery. I mean what happened to the $50,000 you maybe did not use last year? i feel like i'm rambling, but do you know what i mean?:confused:

LindaRacine
08-05-2009, 11:28 AM
Hi Pilar...

I'm so sorry you're going through this. The healthcare system in the U.S. really sucks. If it's legal for insurance companies to set limits, and I believe it is, I doubt there's much your representatives can do. I wonder if you can get someone in the media interested in your case.

In most cases, I'd encourage an individual such as yourself, to get a good full-time job with insurance benefits as quickly as possible. But, with your large curves, time is certainly an enemy.

I can probably find a surgeon who will do the surgery at no cost, but the hospital expense is still likely to be significantly over your $50,000 max.

I'll ask around up here and see if anyone has any ideas for you.

Hang in there.

Regards,
Linda

pilar
08-05-2009, 03:28 PM
well, I guess there is no surgery for me...
The Dr.'s office called today and they said that my insurance will cover hospital expenses and such, but my Doctor doesn't agree to do it cause he thinks he will not get paid for his services. Basically, what his assistant told me today on the phone was that the doctor will not perform the surgery unless there is a financial agreement first. That is me paying him 18,000 dollars.
I do not have that money, so I guess here I am... back to the drawing board.
My only hope is that I can find a very good job and good insurance in 2 years when I graduate from school.
Thanks to all of you for your support and kind words.
Pilar

LindaRacine
08-05-2009, 04:16 PM
Hi Pilar...

Have you thought about trying to find a job now, and delaying the last 2 years of college? What if you worked long enough to get insurance, then quit to have the surgery? You'd have 18 months of COBRA, which should be more than enough to get you through surgery and recovery. Obviously, you'd have to pay for your COBRA insurance, but it would be a lot less than $18,000.

Regards,
Linda

asccbodypro
08-05-2009, 09:03 PM
Pilar,

I have no words of wisdom here but I am so sorry that you have this to deal with when you clearly need to have your surgery. I'm not sure if this is possible but could you be placed on your parents insurance plan since you are a fulltime student? Good luck with whatever plan you come up with. keep us posted!

valleygirl
08-05-2009, 09:19 PM
Pilar,

I, too, am so sorry for what you are going through. There have been many ideas posted here to combat what you are going through. i truly hope one of them may hold the answer for you.

Best of luck to you!

RitaR
08-13-2009, 07:53 PM
Hey Valley Girl.....Im also a former Milwaukee wearer. hated it too. Every minute of it. Wasn't sure I'd ever be rid of it. And, what good did it do me? I'm at 80 degrees now and most likely looking at surgery. Ugh!.

Bionic Woman
08-13-2009, 07:59 PM
So sorry to hear about the insurance problem. My only idea is possible state aid? I don't know anything about your state. I'm from Michigan and know we have Medicaid. What about finding another surgeon? I'll be praying for you.
Debbie

pilar
08-13-2009, 08:18 PM
Thanks everyone!
I have been trying to look for some other ways to get this done, but It seems that all I find is a wall at the end. I'm from california, and none of the surgeons woks with it.... ahhh. I don't know what I am going to do. On top of it, I have been having the worst chest pains ever latetly. My whole rib cage hurts....
Pilar

jrnyc
08-14-2009, 05:08 AM
Hi Pilar
do you have Medical? i would give the congress/senate people a try..what do you have to lose? if you contact them, AND the newspaper, & tell them that your insurance will not allow an urgent surgery..what with all the noise and press about the health care system in our country, just maybe you can get some attention...also, sometimes congresspeople know of benefactors who can help...i really think it's worth a try...i got help when i sent a letter to AARP (i realize you are not old enuf) to publicize that my husband's hospital trip for a severe bout of flu was refused by Aetna...i sent a COPY of the letter i wrote to AARP to our insurance company.. the result... our bill was PAID IN FULL!!! that's all it took, the possible embarrassment to Aetna of the publicity, and Aetna was moved to pay the bill!!!! You have nothing to lose trying....

best of luck
jess

debbei
08-14-2009, 06:18 AM
Hi Pilar
do you have Medical? i would give the congress/senate people a try..what do you have to lose? if you contact them, AND the newspaper, & tell them that your insurance will not allow an urgent surgery..what with all the noise and press about the health care system in our country, just maybe you can get some attention...also, sometimes congresspeople know of benefactors who can help...i really think it's worth a try...i got help when i sent a letter to AARP (i realize you are not old enuf) to publicize that my husband's hospital trip for a severe bout of flu was refused by Aetna...i sent a COPY of the letter i wrote to AARP to our insurance company.. the result... our bill was PAID IN FULL!!! that's all it took, the possible embarrassment to Aetna of the publicity, and Aetna was moved to pay the bill!!!! You have nothing to lose trying....

best of luck
jess

Pilar,

Jess has a really good idea. It's worth a shot. Good luck.

LindaRacine
08-14-2009, 10:00 PM
Pilar...

I've assumed that you've actually read your insurance policy, and confirmed that the $50,000 cap is real. If that's not the case, you definitely have a cause to fight. If the $50,000 is in writing, I doubt that any amount of complaining will make a difference.

Regards,
Linda

Qikdraw
08-17-2009, 03:01 PM
Pilar,

I found this site: http://www.modestneeds.org which gives help in small doses, but this link: http://www.modestneeds.org/help/grants/rak.asp might be better for you. It has a maximum of $10,000 but thats a step in the right direction. Its only for those in the Greater Los Angeles area, so you should be eligable.

I hope this can help you out.

Brad

pilar
08-17-2009, 06:59 PM
Thanks sooo much Brad!
I just filled the application. Wish me luck!:)

Qikdraw
08-17-2009, 08:17 PM
Good luck to you!

Its not exactly a surgical place, but it never hurts to try and see, if they can't help you maybe they can point you in the right direction. :)

pilar
08-22-2009, 12:27 PM
Well, no luck there either. For some reason I didn't qualify.
Anyways, thanks for your help guys!
Pilar

Qikdraw
08-22-2009, 02:54 PM
Sorry to hear that. :(

Is there some way to contact them to ask them if they know of somewhere you can get help?