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Insurance Drama

JulieAJJulieA Posts: 1,420
edited 06/11/2012 - 8:38 AM in Neck Pain: Cervical
OK so I emailed my insurance co today and they didn't respond in 6 hours so I called them.

I had a nice young man answer the phone. I asked when I could expect the denail letter so that I can start the appeal process. He stuttered (I said it can't be that hard Blue Cross sent me the approval last week). He say's can you hold for a minute? 20 minutes later he said the denail letter is "in house right now- that they re writting it"...

OK I take a deep breath. I asked who denied me and what were her credentials? He says it is an RN. I said my NS RN or who? He says an RN in our office. When I pressed him for a name he said it will be on the denail letter- when I get it.

I take another deep breath as he tries to hurry me off the phone. I said wait a minute. I need more information. OK- he says what else do you need? I said I want a copy of my file sent to me so I can review what my NS office has sent in and see if there is anything pertinent missing. He doesn't want to send it. I said look, I am trying to make sure all my ducks are in order for when I start the appeal process. I said you legally had 10 days to get me the denial letter and it has been more than 10 days.

I also asked for an updated benefit book. He stops me and says I need to go to my HR for that.... Really? He says I should get a new one at the end of the year... Is he that stupid? I need the current one that they are basing my denial off of. I never recieved a new one this year. I will call my HR tomorrow.

Newest symptom- Sharp Pain in the front of my neck almost in my throat. Constant hand/arm burning and tingling and sharp pains in my neck at the top of my shoulders. I did speak with a nurse last friday but my NS was in surgery.




  • Hello Julie,

    I am sorry you are having to deal with a unfeeling insurance company and talking heads they hire. I don't have any experience being told I cannot have a procedure (as of yet) but I wanted you to know you are in my thoughts and I pray you will get good news soon. Don't ever give up.

  • Isn't it amazing that a RN working for an insurance company is smarter than your neurosurgeon :))( You were nicer to the young man than I would have been. With all of the news about health insurance reform, maybe you should contact your congressman for help? There have been 3 month old babies denied for prexisting conditions in the news lately! Unbelievable =)) As soon as the news stories came out, the insurance co's reversed themselves.

    Unlike Rick, I have been denied an MRI by my ins co, even tho my dr said it was medically necessary. Now, a year later, I'm in worse shape, same as you, only you are progressing more rapidly. I hope you can get this straightened out soon, and get your needed surgery. Good luck >:D< .

  • jlrfryejjlrfrye ohioPosts: 1,110
    You do not need the denial letter to do your appeal. Call the insurance company and ask for the internal control number and they have to give you a reason for the denial. When you call ask for a supervisor and explain that the answers you are not getting are not acceptable and that they have broken their contract by not giving you your letter within the 10 day time frame. Or you could get HR involved. It is actually with your company that they have broken contract. I would do a three way call with your insurance company and HR. Tell your insurance company that they are causing un neccessary pain and possibly permanent damage. It sounds like to me the gentleman you were speaking with was just giving you the run around and you do not have to accept that.Your HR may be able to get bc to fax them a copy of the denial. I deal with BC on a daily basis and also have BC myself and I believe they do anything to delay a high dollar claim. Unfortunatly it is all a game. If I can help you with anything concerning this please feel free to contact me. Its what I do for a living.
  • Amazing that she called to tell me that they are sending everything to me that I requested yesterday.

    She said the RN's decision was based on the recomendations of the pain dr who did my EMG/NCS.... I said they sent me there to rule out carpal tunnel and you are basing your decission on that. I told her this guy tried to sell me on the services of this clinic or to steal a patient away from my NS. She said is this the same NS who performed your neck surgery last summer? Umh yeah but it was a lumbar surgery.... She said she knows nothing of the "selling of services" and said I need conventional treatment based on the RN's notes.... I said I am risking permanent damage, I am hardly functioning. I haven't slept a full 4 hours let alone 8 in months. My pain and numbness is pretty much constant. I have numbness coming into my right lower leg at times as well.

    It wasn't a pretty conversation- I told her I would be turning the information over to an attorney and asked her what would happen if I need to go to the ER because of pain. She said she can't do anything about it they have to pay the bill when it comes through.

    I also called my NS nurse again and spoke with her. Their hands are tied. She actually spoke with this "RN from the insurnce co", she said that I have to go through the 8 weeks of PT.

    Last night was aweful. My pain came up high and has been there all morning. I have a food show tonight till 9 pm (should be loads of fun).

    Susan, When I get my notes/letter I will PM you. Thanks for the offer.

    Maggie- you need to get an MRI what the heck. Please get back to the dr and demand one. I think you have a good case for taking those creeps to court. Geeze!

    Rick- thanks for the support

    Have a wonderful happy day..... :O)


  • I'm glad you're being persistent and saying that the waiting can cause permanent damage is important. I think if the Neurosurgeon wrote that you have more symptoms like the pain in your throat it may help your appeal. It gets me also a Kinesiologist who works at my Insurance company is trying to override my Primary and Neurosurgeon that say I can't work now and they're trying to get me trained for a desk job even though the Professional Doctors say I can't work, I can't sit or lift. All they did was get me put on a blood pressure pill for their hassling me. All they're in it for is the money. I hope everything goes through for you soon. Take care. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • I finally recieved the "much anticipated" letter of denial. I had also requested my records and the benefit breakdown....

    I recived a letter and the reasons why, the benefit breakdown but 0 records. Last year they overnighted it. This time it came snail mail.

    So they are saying the reason for denial is that my NS and this pain doctor advised these other treatments that I turned down.

    The list of treatments are: Physical Therapy (started yesterday), Tractions (tried & failed yesterday), Celebrex (OMG I can't take but I was taking Relephen until I started to develope an ulcer), & ETC..... (they actually wrote ETC...) :O)

    I did recieve a call from my manager this morning. He had called the owners of the company and got them going on this. One of the owners called and said I need to speak to a different person at the insurance compant. I ran out of time today but will do it monday.

    My NS never suggested PT or traction. His input was I may be able to delay the surgery with injections or traction but it was not going to fix my problems.

    I recieved a second approval letter from my husbands insurance (blue cross) they gave me a new date of Nov 19 (maybe the nurse re-requested?)...

    Should I ask for a new script of celebrex just to say I tried it? Or do you think they will except the Relephen (as a suitable equivilent)?

    Peace my spiney friends.

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