For Anyone Having Issues with Insurance Denial

[LindaRacine]

http://www.isass.org/newsletters/spi....html?sm112911

[rohrer01]

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.

[Mojo's Mom]

Thank you, Linda. This ought to be a "sticky" on the forum, if you know what I mean.

[mabeckoff]

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?

[mjpj]

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.

[rohrer01]

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!

[gardenia]

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

[jrnyc]

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

[gardenia]

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

[jrnyc]

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

[gardenia]

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.

[jrnyc]

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

[gardenia]

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...

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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....