Blue Cross Denied Fusion - Help Needed

[dshobbies]

Dr. P,

I agree with you but there is a huge problem with our current system. Aside from the only people making any money are the ins co, my self employed husband and I were paying $1800 per month for health covereage (PPO). We couldn't afford it anymore and switched to $1200 very high deductible policy, also PPO. HMO's weren't any cheaper, but had less deduct/copays. If we couldn't get a small group policy I'm basically uninsurable because of my history.

We both turn 60 this year and the high deductible policy is going back up to $1800.

My son can't even afford food and has no coverage at all. Another son's wife has coverage from work but they recently cancelled all spousal ins. He had to get his own policy. Work is decreasing their contribution so they're paying much more for less coverage. 3rd son also must pay higher % of premium.

The idea that anyone has the right to tell me or my doctor what they will or will not allow for medical treatments is a bad one. I don't think anyone disagrees with that statement. The rich will live, the poor will suffer. But $1800 per month is a mortgage payment. The system wasn't broken until HMOs entered the game. Why not simply outlaw any managed system and we'll go back to the way it was????????

Business is bad (big wow there) and we simply cannot afford this anymore. If one of us is hospitalized or needs surgery- ouch! Something has to change.

Dale

[AnnOdom]

DSHOBBIES, you are exactly correct about health care going down the tubes when HMOs came on the scene! I'm a retired R.N., graduating in 1965, so I've seen the changes in the insurance industry since HMOs became "popular." And, of course, they started in California! I worked with a nurse anesthesist who worked at Kaiser Permente, which was the first HMO. Dr. P is right, we've got to keep the heat up on our legislators as obamacare will destroy our health care system, which has been the best in the world. Breaks my heart to read these posts about denials. Workers' Comp carriers are just as bad. They find quacks who'll report in favor of the insurance company, and that caused my DHs lumbar fusion to be delayed for ONE YEAR! He was in such pain that he rarely was able to leave the house. Praise God, he was fused on Dec 1st, using the Medtronic CD Quadrant Sextant System, and is doing just great! Even better than his neurosurgeon expected, this soon post-op.

[jsewell]

My orthopedists office will not book surgeries until they have the approval code in their hand.

for my last surgery of Jan7th. My head was on my chin with x-rays showing a 90 degree turn at the top of my thoracic spine and I had equipment sticking out of my back from my recent thoracic/lumbar fusion/osteotomy. Not to mention the pain getting worse every day. I just stayed in bed toward the end it was too painful just to walk and i know i looked weird as i could not put my head up.
Well the surgery was denied by Blue Cross of Ca. The doctors office was right on it and the peer to peer happened within days. I was told it was going to be approved probably the next day. Well i faced 2 more denials,of not neccessary.
I was lucky the assistant at my surgeons office was so confused with all my paperwork as i had 3 surgeries in a row that she set up the date of Jan 7th.
Once i got really involved i realized my spine docs office had never sent the xray. So i went to his office to get the Ctand MRI , i already had the xray as it was so unbelievable, got all the reports and told them i was driving the 2 hours to Blue Cross to deliver it as they never got the xrays there.
Well then the office person asked where i got the xray. I told her everything came from their office and if they could email it all i did not havea to make the drive. My poor doc had 2 other peer to peers also and it finally got approved, but 3 denials first.
All for an error. also Blue Cross told me there was a coding error as well. I can't believe they would not just fix it instead of keeping it a secret as to what is wrong.
To save my date i had told them i would self pay . My doctor assured me no surgeon could deny this after seeing the xray. They just wanted someone other than him to say what was going on. So i was not afraid to put my self out on a limb but really would have to get the money from my parents.
Good luck and let me know if you need a body to join you at Blue Cross office.
judy