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Thread: $$$ for surgery

  1. #1
    Join Date
    Jun 2009
    Location
    Los angeles
    Posts
    122

    $$$ for surgery

    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

  2. #2
    Join Date
    Jul 2008
    Posts
    407
    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.
    Surgeries July 26th & August 3rd 1983 (12 years old)
    Still have 57 degree curve
    2 Harrington rods
    Luque method used
    Dr David Bradford
    Twin Cities Scoliosis Center
    Preop xray (with brace on)
    Postop xray

  3. #3
    Join Date
    Jan 2008
    Location
    Oregon
    Posts
    1,161
    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.
    Gayle, age 50
    Oct 2010 fusion T8-sacrum w/ pelvic fixation
    Feb 2012 lumbar revision for broken rods @ L2-3-4
    Sept 2015 major lumbar A/P revision for broken rods @ L5-S1


    mom of Leah, 15 y/o, Diagnosed '08 with 26* T JIS (age 6)
    2010 VBS Dr Luhmann Shriners St Louis
    2017 curves stable/skeletely mature

    also mom of Torrey, 12 y/o son, 16* T, stable

  4. #4
    Join Date
    Jun 2009
    Posts
    15

    Unhappy

    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

  5. #5
    Join Date
    Jan 2009
    Location
    Ames, Iowa
    Posts
    1,250
    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
    Janet

    61 years old--57 for surgery

    Diagnosed in 1965 at age of 13--no brace
    Thoracic Curve: 96 degrees to 35 degrees
    Lumbar Curve: 63 degrees to 5 degrees
    Surgery with Dr. Lenke in St. Louis--March 30, 2009
    T-2 to Pelvis, and hopefully all posterior procedure.

    All was posterior along with 2 cages and 6 osteotomies.

  6. #6
    Join Date
    Aug 2008
    Location
    Odessa, Texas
    Posts
    43
    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.
    .: St@ci :.
    28 years old
    Mama to two daughters
    Diagnosed at 12 with double curves.
    No treatment.
    Decided on surgery 16 years later.
    Thoracic curve - 65
    Lumbar curve- 63
    Surgery was on January 15, 2009.
    Fused T2-L3
    No more curves now!

    Happier now than ever!
    http://www.lifeiscrooked.blogspot.com

  7. #7
    Join Date
    May 2009
    Posts
    3,745

    surgery $$$

    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

  8. #8
    Join Date
    Oct 2008
    Location
    Sunshine Coast, Queensland, Australia
    Posts
    3,261
    That's horrible, Pilar. I can only hope that someone is able to help you. It just doesn't sound fair. Good luck!
    Surgery March 3, 2009 at almost 58, now 63.
    Dr. Askin, Brisbane, Australia
    T4-Pelvis, Posterior only
    Osteotomies and Laminectomies
    Was 68 degrees, now 22 and pain free

  9. #9
    Join Date
    May 2009
    Location
    Adelaide, Australia
    Posts
    424
    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?
    Vali
    44 years young! now 45
    Surgery - June 1st, 2009
    Dr David Hall - Adelaide Spine Clinic
    St. Andrews Hospital, Adelaide, South Australia
    Pre-op curve - 58 degree lumbar
    Post -op - 5 degrees
    T11 - S1 Posterior
    L4/5 - L5/S1 Anterior Fusion

  10. #10
    Join Date
    Sep 2003
    Location
    Northern California
    Posts
    6,797
    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

  11. #11
    Join Date
    Jun 2009
    Location
    Los angeles
    Posts
    122
    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

  12. #12
    Join Date
    Sep 2003
    Location
    Northern California
    Posts
    6,797
    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

  13. #13
    Join Date
    Jan 2009
    Location
    Virginia Beach, VA
    Posts
    455
    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!
    Susan

    Diagnosed at 10, Boston brace from 11-13 yrs old.
    50* Lumbar w/ 5 centimeter shift to the left and slight rib hump...
    Surgery Date: April 15 and April 22, 2009
    X-LIF approach for disc repair L5,L4,L3,L2
    Posterior Approach for fusions L5-T5
    Dr. Fox @ Naval Medical Center Portsmouth
    Nice and straight now!!!!!

  14. #14
    Join Date
    Jul 2009
    Location
    Los Angeles
    Posts
    61
    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!
    ValleyGirl - age 54

    Diagnosed @ age 11
    Milwaukee brace 1967-1971 -- hated it!
    Never rechecked since 1971 until "tweaked" something in lower back in July 2008.
    Now curve is T38*, L53*
    Surgery scheduled for 9/8/09


    Fused T10 - S1 on 9/8/09

  15. #15
    Join Date
    May 2009
    Location
    Topeka, KS
    Posts
    397
    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!.

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