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  • For Anyone Having Issues with Insurance Denial

    http://www.isass.org/newsletters/spi....html?sm112911
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

  • #2
    Thank you, Linda. I'm not having trouble with denial of surgical coverage, they just flat out won't let me get a second opinion.
    Be happy!
    We don't know what tomorrow brings,
    but we are alive today!

    Comment


    • #3
      Thank you, Linda. This ought to be a "sticky" on the forum, if you know what I mean.
      Stephanie, age 56
      Diagnosed age 8
      Milwaukee brace 9 years, no further treatment, symptom free and clueless until my 40s that curves could progress.
      Thoracolumbar curve 39 degrees at age 17
      Now somewhere around 58 degrees thoracic, 70 degrees thoracolumbar
      Surgeon Dr. Michael S. O'Brien, Baylor's Southwest Scoliosis Center, Dallas TX
      Bilateral laminectomies at L3 to L4, L4 to L5 and L5 to S1 on April 4, 2012
      Foramenotomies L3 through S1 in August 2014

      Comment


      • #4
        Originally posted by rohrer01 View Post
        Thank you, Linda. I'm not having trouble with denial of surgical coverage, they just flat out won't let me get a second opinion.
        So your insurance plan wants you to have a very expensive surgery without a second opinion?
        Melissa

        Fused from C2 - sacrum 7/2011

        April 21, 2020- another broken rod surgery

        Comment


        • #5
          Originally posted by rohrer01 View Post
          Thank you, Linda. I'm not having trouble with denial of surgical coverage, they just flat out won't let me get a second opinion.
          Rohrer, You are in Madison right? We are too and are having the same problem. Grrr. Let me know if you get anywhere.

          Comment


          • #6
            Originally posted by mjpj View Post
            Rohrer, You are in Madison right? We are too and are having the same problem. Grrr. Let me know if you get anywhere.
            I don't live in Madison, but my insurance will only let me see Dr. Tribus, who is in Madison. I like him as a person, but as a doctor he seemed quite forgetful, at least the last time I saw him. I was very frustrated and left in tears. He wants to wait until my curve is at least 60* even though I am in pain and progressing. I'm not quite sure what my measurements are, as the radiologist said I had progressed and measured me less than the Dr. did. Yes, my insurance will pay for surgery when Dr. Tribus gives the okay. NO second opinion allowed. I think that's just crazy!
            Be happy!
            We don't know what tomorrow brings,
            but we are alive today!

            Comment


            • #7
              no second opinion - not expesive surgery

              Originally posted by mabeckoff View Post
              So your insurance plan wants you to have a very expensive surgery without a second opinion?
              You see that these are smalll insurances (as all of them are about making money). They will not allow a second opinion because they have to pay all over again and in your case you can do it but with out of pockie.

              The surgery is not that expensive, the bill tends to be around the $1M mark that is produced by the hospital is only paid a very small piece as per their agreemen a contracted amount.li
              Gardenia
              Baja California, Mexico & El Centro, Ca
              pre-surgery 75 and 89 - post ?
              Dr. Bridwell Nov 27, 2012 @Barnes Jewish @62yrs
              T11 to Sacrum Dural leak at L2 & L3 ccmail4g@gmail.com

              Comment


              • #8
                i do not understand...how is a million dollars
                not expensive....????? don't the insurance companies have to
                pay a hundred thousand...at least...?

                jess

                Comment


                • #9
                  $1M in hospital billing

                  I might not understand your question, Jess.

                  The hospital gets billed $1M (adding different stuff, including an aspirin at $25 years ago for my mom at the hospital) The contracted amount is sometimes as little as single digit percentage. I have been billed so far for xrays, visits, labs etc and the amounts negotiated is amazingly low.

                  Now, if one does not have insurance then you pay the hospital bill. Or, you live with the pain.

                  gardenia
                  Gardenia
                  Baja California, Mexico & El Centro, Ca
                  pre-surgery 75 and 89 - post ?
                  Dr. Bridwell Nov 27, 2012 @Barnes Jewish @62yrs
                  T11 to Sacrum Dural leak at L2 & L3 ccmail4g@gmail.com

                  Comment


                  • #10
                    i was saying that a million dollars is a lot for surgery....
                    i do not know of other surgeries that cost more than
                    that...
                    the fact that insurance companies get away with paying
                    a small percentage of the bill, to me, doesnt change the
                    fact that the total cost of scoliosis surgery is very expensive...

                    jess

                    Comment


                    • #11
                      I just read it somewhere

                      It is not only for the surgeon but the operation room, anesthesia, monitoring of the spinal cord, tests, xrays, hospital stay, etc.

                      Yeah, it seems high but I have also read that the insurance ends up paying like $200K average. And, I was quoted that a gram of the BMP is very costly when you need multiple amounts.

                      I wonder if people who had recent surgery would add up and share their billed cost versus the negotiated cost.
                      Gardenia
                      Baja California, Mexico & El Centro, Ca
                      pre-surgery 75 and 89 - post ?
                      Dr. Bridwell Nov 27, 2012 @Barnes Jewish @62yrs
                      T11 to Sacrum Dural leak at L2 & L3 ccmail4g@gmail.com

                      Comment


                      • #12
                        yes, i realize it includes everything...
                        i do not know how that price compares to open heart
                        surgery, for example...
                        if someone does not have insurance, scoli surgery
                        is prohibitivly expensive

                        jess

                        Comment


                        • #13
                          United Health Care pre-authorization DENIED- REVERSED!!!!!

                          UPDATE: Dr. Bridwell upon my plead, called the insurance for a Peer to Peer appeal. Got UHC to reverse and approve my surgery. Thanks everyone who responded in sympathy.

                          I had started looking at different places with different techniques and demanding the insurance to give me a list of approved methods and surgeons (fortunately did not get there).

                          I was going to complain about the high cost of having the OPEN CHOICE when actually I was not going to be given any choice. But Thank You all for your prayers for saving my back and my impending war with the insurance company.

                          I am now Scheduled for Nov 27th after the doctor office erased my name off the schedule...

                          ----------0-------------

                          Well, I just got the expected call this morning.

                          I called my insurance and the next step is a PEER to PEER call, I got an indication that BMP denial is very hard to reverse. But, I am not giving up....
                          Last edited by gardenia; 09-18-2012, 11:57 PM. Reason: Status Change
                          Gardenia
                          Baja California, Mexico & El Centro, Ca
                          pre-surgery 75 and 89 - post ?
                          Dr. Bridwell Nov 27, 2012 @Barnes Jewish @62yrs
                          T11 to Sacrum Dural leak at L2 & L3 ccmail4g@gmail.com

                          Comment

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