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        New Message Board Archives >> 2002 Posts >> Insurance keeps me from seeing Neuro now
        
(Message started by: Leggs on Aug 10^th, 2002, 10:21am)

Title: Insurance keeps me from seeing Neuro now
Post by Leggs on Aug 10^th, 2002, 10:21am

I know in differents posts, everyone has urged me to find a neuro. You know what the biggest thing preventing me is? INSURANCE.

I have insurance, but it is through my husband's union, so we have no recourse to the insurance commissioner in our state.

I just had major surgery in June, and they essentially have paid 1/3 to all my providers. One procedure, where the wall of my abdomen was rebuilt, through laporoscope I might add, the charge was $3000. Because I had other procedures done at the same time, they only paid $400. I was in surgery for close to 4 hours, but I went home the same day, the advantage of laporoscopic surgery. I was walking on my treadmill in a week.

Well, they have this "board" who decides what is reasonable and customary who you submit appeals to. They have no sense, they have no insight into what is medically going on. I am going to appeal every last charge on the procedure from the surgeon, anethesiologist, hospital etc. I am currently researching resources for "usual and customary charges." You know it's illegal for doctors to confer with one another about their charges? Where do these "charges" come from? They are made up by this board of idiots.

I am not putting up with it anymore. My doctor is making a HUGE discount on his charges, but I am appealing anyway. I want to try and start some kind of website, where we send massive amounts of appeals to these "boards of monkies" and maybe something would change. We are running decent doctors out of business. The insurance companies aren't doing their jobs, they are hitting us and the doctors and hospitals in the pocket. I KNOW doctors make lots of money, but some of the managed care/ppo stuff and the contracts involved give the insurance total discretion over how far the can discount charges.

If I went to a neuro, I would have to pay 20% of the bill I would be a new patient and I know I can't afford it right now. We have made 3 COBRA payments in the past 2 months, another due the beginning of August of $500. My husbands job has been in the toilet since 9/11.

Prayers these blasted headaches just go away!

Title: Re: Insurance keeps me from seeing Neuro now
Post by 2late on Aug 10^th, 2002, 11:03am

sorry about your situation,i belong to a union & it's great! but i sure could'nt afford to be on their insurance.i can't see how u get any relief without seeing a neuro & gettin' on some kind of med program. hang in there! maybe you'll be at the end of your present cycle& get a break.good luck, check meds & therapy board, maybe u can find an alternative treatment to get u thru.best of luck to ya!!! .........2late

Title: Re: Insurance keeps me from seeing Neuro now
Post by pjbgravely on Aug 10^th, 2002, 12:25pm

I thought my union insurance was bad becouse they only paid 80% of my visits. I will be praying that you get better and your husband gets work.

Title: Re: Insurance keeps me from seeing Neuro now
Post by Leggs on Aug 10^th, 2002, 2:51pm

Hey, we live in Georgia, does that give you any insight into the union situation?

They automatically take "assessments" out of his check when he is working, quite a chunk. THEN our insurance is from the local he worked through when we moved here, because they messed up the reciprocal agreement when I was in the middle of my first pregnancy. CAN IT BE ANY MORE COMPLICATED? Even if I got a job and had insurance, they would still take the chunk out, he doesn't have a choice.

Also, we don't live in our home local, for the past 7 years, so he is a traveler. There is no chance of him being voted in. The Atlanta local has consistently been taking in any Joe Blow off the street for years now just to get the dues. There are lots of local Atlanta men who dearly love my husband, but I cannot blame the membership for not wanting to vote in a traveler when THEY aren't working. There are so many total idiots working in that union, guys who just turned out (IBEW), and carry their cell phones aroung bsing with their girlfriends all day.

Then these guys totally brown nose their way up the ranks, it's really discusting, then he hears them complaining how they have been laid off 5 weeks this year, and he has been laid off 5 months. You just want to smack them. My husband totally works his tail off whereever he goes. He's just that kind of guy.

As union guys know, his insurance eligibility is based on hours worked. We became ineligible for June when he was 1.5 hours short! We had to pay the COBRA THEN, since I needed an operation in June, instead of putting it off as long as possible until August. He worked a month, so we know we are eligible for July, but had to pay anyway. Now we are just waiting for reimbursement which can take months, and will have to turn around and mail it back. They WON'T just keep it, it's like the want to trip us up and make us ineligible, turning all conditions into preexisting. Ugh! Hey, I want to beat my head against the wall when I don't have a CH!

Title: Re: Insurance keeps me from seeing Neuro now
Post by Charlie on Aug 10^th, 2002, 4:08pm

Rats.

The deal is; I have epilepsy. That's thought of as a "real" disease and the insurance jerks are terrified of us. There have been too many successful lawsuits from us, so they treat us with kid gloves. Anyway, this gets me instant neurologist appointments from damn good doctors. They know me and I know them so well, they sometimes pay attention.

Mebbe, you could do better by getting a referral from your PCP (if he'll play ball) for what he can call an "exploratory" consulting thing. I'm probably behind the curve here but I had to write it.

Effen HMOs.

Really mad old Charlie

Title: Re: Insurance keeps me from seeing Neuro now
Post by Leggs on Aug 10^th, 2002, 4:21pm

I had to laugh, Charlie, I actually am not in an HMO next "best" thing, a PPO, Blue"choice" implying I can choose my own doctor if they are part of the network, get 100% payment after the first $7500 paid each year. The tricky thing is, that is the exact wording from the manual, but the first $7500 is exactly WHAT? The total claim, the usual and customary the insurance delegates, the wacked amount the actually pay the physician?

I will tell you, I am a bloody literalist, their wording allows insurance total discretion over what they pay. I am making a huge stink about what they paid on my operation, sending them copies of all their stinking manual pages and EOB's, cc: to the U.S. Department of Labor, states attorneys office for fraud, all my congressmen and senators from the state to the United states, and the President!

Don't get someone with CHs peeved. We ARE from another planet in this condition, and we don't play by the rules!

Title: Re: Insurance keeps me from seeing Neuro now
Post by Charlie on Aug 10^th, 2002, 5:16pm

I have Community Blue here. It runs me $2,000 a year, lets me use physicians in the plan, pays all but $11 of of my prescriptions (my seizure stuff would cost more than $1,200 alone) and I have a small deductable for the hostpital. I can't remember the figure. Some of the time I win battles with them. I hate them but I've had good luck lately.

Good luck with yours and make one hell of a stink. Jonny and the rest of us with be glad to help with our BBBs. Get Ted to write the letters. He's scary :o

Really dangerous old Charlie

Title: Re: Insurance keeps me from seeing Neuro now
Post by Leggs on Aug 10^th, 2002, 6:35pm

Well, I will keep you guys in mind if I need back-up. I have been know to be a real blankety blank on wheels when I need to be. I had a $1500 car bill written off when I pointed out to them I had never signed any authorization to do anything but "check" the universal joints. It was on a 280z, then Datsun, I already had 3 of the same car, I knew what was wrong.

In my medical griping realm, I had my insurance company pay an additional 30% to my physician after I filed an appeal. I gathered usual and customary info from all around the country on a procedure only 10 people in the world were doing at the time. They had paid him squat (in fact, this is the same surgeon I am fighting for now), they paid like he cut me open and I was in the hospital for a week. There was no difference in usual and customary for surgery where I was cut open and in the hospital for a week, or if they did it allthrough my bellybutton and I went home the same night.

But you know, I DID get the 30% more. If they are paying crappy, we need to get crappy with them! My brother has always called me the Tazmanian Devil since I was young. You get me wound up about something and WATCH OUT!

Uh, I am new here, translation on the BBBs, please. Now I just have to remember where I found all the decoding of the lingo here.....

Title: Re: Insurance keeps me from seeing Neuro now
Post by Drk^Angel on Aug 10^th, 2002, 8:08pm

My dad was IBEW... I don't think he ever worked out of his home local but once. About the only way he found work was by signing the book in a new location every 6 - 12 months. Lived almost a dozen different places before I graduated high school. Don't remember my parents having too many troubles with the insurance, but then again, I wasn't doctoring for CH back then either, and my parents never needed anything but "Customary and reasonable" (I hate that phrase, and every other phrase these insurance companies bury in their policies. Who are they to say what's reasonable or customary.) proceedures. Good luck Leggs! I hope you and your husband get your situation worked out soon.

PFDAN................. Drk^Angel

Title: Re: Insurance keeps me from seeing Neuro now
Post by Charlie on Aug 10^th, 2002, 8:45pm

BBBs are Jonny's Big Black Boots with which he threatens to settle arguments. I'm told he has had good luck so far ;)

Many moons ago, I got stuck in a Baltimore hospital..1983, I think...had a gallbladder attack. Anyway this St. Elsewhere from hell wanted me there for eternity for countless tests (unnecessary) which were about twice than back home and horribly expensive rooms. I had no insurance then and had the work done at home. Of course, I got a big bill from these jerks anyway. My family thought I was horrible but even though I had the money, they were so nasty and threatening that I paid them $50 a month. They began sending more threatening stuff and I wrote that from then on, it will be $25 a month and you have to send a prepaid envelope and make nice or it will be $12.50, then $6.25. They shut up and stopped billing when it hit $49. They can't do much after it gets below $50. What they didn't know was that I would have paid.

Anyway, maybe you can set up something like this. Just an idea and keep giving them hell 8)

Really cheap old Charlie

Title: Re: Insurance keeps me from seeing Neuro now
Post by Leggs on Aug 10^th, 2002, 8:46pm

Even though I was born a Yankee, as they would say here in Georgia, THERE IS FIXIN' TO BE A STINK IN GEORGIA!

I just found out from an editorial of August 7, there is CURRENTLY a lawsuit against MY insurance company in Georgia about keeping the "usual and customary" under a veil of secrecy. This is EXACTLY what I am griping about! Now I have some ammo.

http://www.ama-assn.org/sci-pubs/amnews/amn_00/edsa0807.htm

Like I said, you don't mess with a clusterhead!

Thanks for the good luck, Dark Angel. You know where I am coming from re: the unemployment thing and IBEW. Anybody know of any hot spots in the U.S. for a GREAT Electrician, and a helluva guy? P.S. Did you all know all the firemen lost in 9/11 were IBEW brothers and sisters?

Title: Re: Insurance keeps me from seeing Neuro now
Post by Drk^Angel on Aug 10^th, 2002, 8:54pm

I don't know of anyplace hiring for anything right now. Maybe your husband can look into the state paying for retraining. Some states offer state funded retraining for unemployed and/or disabled workers. My dad became disabled after a fall at work, and the state paid for retraining to become a computer technician. That was in MI though. Don't know if GA offers anything like that.

PFDAN.................. Drk^Angel