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Thread: Denial of Insurance

  1. #1
    Join Date
    Nov 2004
    Location
    Bloomington, IL
    Posts
    43

    Denial of Insurance

    I recently visited my long time physician this past November for a 2 year check up. I have been seeing this physician for the past 35 years and never once gave it a thought about a referral. Of course the insurance wouldn't pay for the visit and films after the fact, but now I seem to be in for the fight of my life as the insurance has denied my request for a referral. The physician "suggested" through the network is not specialized in spinal fusion and I am scared to death that even in the appeals process that this won't go through. Has anyone had this problem before and if so what did you have to back up your case with?

  2. #2
    Join Date
    Sep 2003
    Location
    Northern California
    Posts
    6,795
    Sue...

    Welcome to HMO hell. I had a similar experience, and opted to switch to a PPO plan (which costs considerably more).

    --Linda

  3. #3
    Join Date
    Dec 2004
    Location
    antelope, california
    Posts
    11

    Post insurance

    I lost my job because of my back, and then my insurance. I have been on State medi-cal for about 3 years now. I also get denied everything from meds to pain management and specialists. You calmly find out who makes the decisions and start emailing or calling these people and make sure you send them facts and reports from well-known specialist that know what your condition needs. I am in the process of applying for insurance in a different county that offers better coverage, and I think I found a wonderful Doc. who has been talked about on this forum. I know that it gets beyond frustration, but you can not give up. You must keep calling your HMO and keep asking to talk to the person higher up than the person your talking to. Make sure You write to these people and tell them of your plight. I think that hospitals and insurance companies are not very aware of this condition and certainly do not understand the pain we go through. Sometimes I think they know, and because of the progression and cost, they try to stall you as long as possible. I had a director of an E.R. hospital at Mercy San Juan in Sacramento come down and tell me in a very nasty way that there would be nothing they could do for me until I can't walk anymore. At the time I did not even know why I was in so much pain. The nurses were shocked at his behavior.
    It is always about money, so make sure you have your facts and talk with confidence about what you need to be a healthy productive person.

  4. #4
    Join Date
    Sep 2005
    Posts
    1
    try checking out http://www.oneshopinsurance.com , might help you with your concern
    Last edited by bostonblizzard; 01-04-2006 at 09:37 PM.

  5. #5
    Join Date
    Nov 2004
    Location
    Bloomington, IL
    Posts
    43

    I Beat It!

    It's been a while since my initial post on the Insurance Denial, but I feel that I have won a small battle in the process. I work for a hospital, so I met with the Medical Director and we came up with a plan. I don't submit an appeal I go see the physician that the HMO recommended...following their rules, knowing full well that he did not specalize in Scoliosis, let alone the surgery. New X-rays, wasting his time and mine, he of course said that he does not do any type of scoliosis surgery and his recommendation was for me to see Dr. Keith Bardwell in St. Louis - stating it was a "second opinion". My doctor of 35 years was Dr. Ronald DeWald in Chicago, but Bardwell actually did a Spine Fellowship under DeWald and is one of the best in the nation. Mission Accomplished!
    48 year old Female
    3 curves...35, 56, 43
    Proud wearer of Milwaukee Brace in the 70's...and hated every minute of it.

  6. #6
    Join Date
    Sep 2003
    Location
    Northern California
    Posts
    6,795
    It's Keith Bridwell (mentioned only because I thought you might have trouble finding him).

    --Linda

  7. #7
    Join Date
    Jan 2006
    Posts
    2
    Quote Originally Posted by bostonblizzard
    try checking out http://www.oneshopinsurance.com , might help you with your concern
    they're offering quotes from different insurance companies.

  8. #8
    Join Date
    Sep 2003
    Location
    NJ
    Posts
    1,291

    Insurance coverage for chiro/Aetna/FYI

    Aetna updates its chiropractic coverage policy.

    Aetna, which does not cover methods that it considers medically
    unnecessary or "experimental and investigational," has updated its
    clinical policy bulletin on chiropractic. The procedures it does not
    cover include maintenance care, Applied Spinal Biomechanical
    Engineering, BioEnergetic Synchronization Technique, Chiropractic
    Biophysics, Cranial Manipulation, Coccygeal Meningeal Stress
    Fixation, Directional Non-force Technique, Manipulation for Internal
    (non-neuromusculoskeletal) Disorders (Applied Kinesiology),
    manipulation under anesthesia, Moire Contourographic Analysis,
    Network technique, Neural Organizational technique, Sacro-Occiptal
    Technique, surface electromyography (sEMG), thermography, Upledger
    technique, and Craniosacral therapy. [Chiropractic services (CPB
    0107), Aetna, March 31, 2006]
    http://www.aetna.com/cpb/data/CPBA0107.html Many of these methods are
    debunked on Chirobase. (http://www.chirobase.org)
    Original scoliosis surgery 1956 T-4 to L-2 ~100 degree thoracic (triple)curves at age 14. NO hardware-lost correction.
    Anterior/posterior revision T-4 to Sacrum in 2002, age 60, by Dr. Boachie-Adjei @Hospital for Special Surgery, NY = 50% correction

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