hello I am a 'spine' too !

KamH. · #1 (**permalink**) 03-12-2007, 12:45 AM

I am having a new problem with my health insurance! I am getting Denials ! I had a 3 level cervical fusion in 98 and I have dealt with problems(Pain) and am on disabilty now for yrs.
I see Dr Merril Reuter who is an excellant ortho (minimal stuff) I just had some out patient stuff (discography) and injections due to pain an fluid ,in july and sept 2006 and am not getting covered thru BC/BS ?? am I losing it ?? sheesh this is getting old ! I think My dr may have already written it off ..But I hate to see him not get his money too ! he has kept me mobile when I am bad !! ..when insurance fails us ...what will happen ? I will be afraid to see my dr ?? any comments ? thanks Kam (S Florida)

dshobbies · #2 (**permalink**) 03-12-2007, 09:57 PM

Kam,

Welcome to the forum and welcome to the spine world and insurance problems. Much has been written about this problem with no solution. I'm very sorry for your suffering and you don't deserve this run-around but that's the way it is right now and in the foreseeable future.

Insurance companies rule the medical field right now and as long as they're in it for the money and have too much politcal clout, it probably won't change. Perhaps we should all send a teabag to our congressional respresentatives since we obviously don't have the big bucks. (I know, a stupid idea but sometimes you just feel like you have to do something!)

Kam, take a deep breath because this may only be the beginning.

Good luck to you, Dale

KamH. · #3 (**permalink**) 03-12-2007, 10:51 PM

Hi Dale (originally from LA too ; just left there )
I am getting that picture as i search internet for some clue as to what is going on .. I have not experienced a denial in yrs ! I can see that it is a game now ..as I write an they deny ! I am not in mood to listen to a half wit tell me about insurance at the billing end of Doc's office either ! I have been with my dr longer then she has been there !! my hub was in insurance business (claims on autos) but I feel like expert after the stuff that I went thru to get claims paid ..we used to Joke when I was first injured ; that I was sleeping with the enemy !!! hub would go to conventions and hear stuff about injury claims for say whiplash (that it was made up and not real ) well I said look at me ! you live with me !! hehehehe he knew I was telling truth !
I had to fight to get my SSDI for 2 yrs !! so I am aware of IME's and I am guessing these 'drs' that review and deny claims are one and the same ? am I correct ?
well Dr Reuter is a great dr and not in it for money (not that it is not a great side benefit

) but I guess for a person with spinal issues .. like any other lingering health issue they would rather see us disappear... then to pay valid claims . I guess I am wondering, when I am desperate again and in pain ...I will also be in mental anguish ! worrying about if it will be covered ! the dr office called for pre approval and were told not necessary ! I guess I wlll have to insist especially if I wind up paying this bill (several thousand $) what is funny BC/BS PPO did pay for my anesthesia?
I am glad to have a place to pick up info and will pop back soon !!!thanks for the welcome ! I was a member for long time of MGH, but have not been in there in a few yrs and I see it no longer exists I guess

Kam