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Surgery 2/3 but will I have to delay? Wish me luck

SpineAZSpineAZ WiscPosts: 1,084
edited 06/11/2012 - 8:40 AM in Back Surgery and Neck Surgery
Luckily I've worked in insurance (and my employer was an insurance company) but have an uphill battle on my hands.

With my employer, when you go on LTD, you are a "disabled retiree". The good news is I'm on the health insurance for as long as I'm on LTD. The bad news is everyone outsources everything these days.

My employer contracts out to a third party to administer premium/billing who then sends a data feed to the health insurance company. My employer failed to enroll me in 2010 benefits in error, so the third party didn't bill me and thus did not then relay to the health insurance company that I'm covered. As of now I technically have no insurance. I must have it by Friday and my doctor's office can't yet pre-certify.

7am Monday I start my calls to anyone and everyone involved. I can't bear the thought of this surgery being delayed. Every party is blaming it on the other. What joy.
2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 


  • SpineAZSpineAZ WiscPosts: 1,084
    I took the step of creating my own "Payment Coupon" duplicating what they send me each month, confirmed what my new monthly rate would be, and sent that in to the third party administrator 12/22 to cover me for January and February.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • Good Luck.
    I had a nightmare a few years back when I left a company and cut over to COBRA. It was a routine exam and the claim kept getting denied b/c the darn insurance company kept putting it thru my active enrolment insurance despite the fact that the doctor kept telling them to put it thru the COBRA coverage. It took 6 months for them to get it right and I had to get both parties on the phone.

    Crazy but it worked out.
    It sounds like you are WAY more on top of the situation than I was. I will keep fingers crossed that things work out so you can keep the surgery date!
  • I'm crossing fingers for you. I can't imagine getting this far and then not being able to have surgery because of an administrative error. Hopefully you can get it sorted quickly
  • SpineAZSpineAZ WiscPosts: 1,084
    I've got my plan of action. I will be writing down the exact times of each call, who I talk to and what they say, etc. I'm hoping that by having such a huge plan it will work out that I need to do nothing more than a few calls :-) "If I prepare to spend all week doing this I bet I won't have to" is my reverse psychology that I hope works.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • Spineaz I feel for you because I have surgery scheduled for 20 Jan 2010 and the thought of not being to have it would not be good for me because of the pain that we endure is too much I wish you all the best and good luck.
  • SpineAZSpineAZ WiscPosts: 1,084

    My husband thinks "oh it's no big deal" if they change it but he doesn't realize how we have to get ourselves psyched up for this. I am currently out of work due to this so he thinks it doesn't matter but for me I am so focused on that date I go nuts thinking "everyting" could change. Thanks for understanding what I'm going through. h
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
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