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Help!! Just terminated, no STD extension yet & surgery in 3 weeks!!!

TatiyanaTTatiyana Posts: 194
edited 06/11/2012 - 8:41 AM in Health Insurance Issues
I hope someone can help me through this maze...

I have been off work since September with a herniated disc in my neck and have an ACDF scheduled for Feb 15..for some reason even though my surgeon wrote me off work until post op, my disability company only approved me through Jan 3.

My case manager sent me a daily activities form to fill out & send back, which I did but I just got a letter that they either need more medical documentation or they will close my case on Feb 10.
My surgery is Feb 15 (which they know) :SS

I asked my primary to fax them office notes from my last visit....still waiting on that.

Meanwhile I have NO income coming in and am not receiving benefits..

Does anyone have any advice on how to proceed? It seems the disability co is trying to get out of covering me! ~X(


  • That's just not right it seems. Hopefully when they get your Doctor's notes they will approve you. I heard you should ask the Insurance for a copy of your policy also. Someone gave me a link also to a Disability Forum
    I hope that it works out for you and find out tomorrow what's going on. If not I guess you need legal counsel.
    Take care and hope you get some rest. 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
  • jlrfryejjlrfrye ohioPosts: 1,110
    I went through the same thing with my std insurance. Send all medical documentation and a letter consisting of all medications and an explanation why you cannot perform your job at this time. Keep on your surgeons office about faxing the letter over. You are more then likely ready to become a ltd claim and this is normal procedure for a insurance company to do. Stay on top of it and once all documentation is recieved they will have to pay back pay that is due. I know this is frustrating. We do all the right things to protect our selves in case of injury or sickness and we should not have to fight for what we paid for when it is needed but sadly disability insurance will make things difficult. Once you surgery is done make sure that you disability insurance company recieved the paper work on that also.
    Good luck
  • I've been there too.
    Susan is absolutely correct. They will eventually cover you,but only if they receive the proper medical documentation. Your surgeons office needs to get those notes from your last visit to them. Just a note saying you cannot work will not be sufficient. They need medical documentation. such as the test he performed while you were there, meds discussed, surgery options etc. Once they receive that they will probably extend your claim.

    Unfortunately we are often caught in the middle. Trying to get these doctors offices to move along can be extremely trying and stressful. (As if you are not stressed out enough with your upcoming surgery.)

    I would call my Dr.'s office and let them know that mt benefits have been cut off and need to know when my benefit company can expect to receive the notes. I would also take them a copy of the letter you received.

    Do you have LTD? It sounds like you are close to moving into LTD. Trust me they are typically more experienced and much easier to work with in these cases.

    Good Luck with this and your surgery.
  • SpineAZSpineAZ WiscPosts: 1,084
    Clearly you've gotten a claim case manager with no common sense. When I used to hire claim case managers I always said "I don't need someone with a bachelor's degree, just someone with common sense".

    Before you get to worried, tomorrow call and speak to the next person up the chain (supervisor or manager - and ask for someone who can specifically address your claim). Explain the letter you received, the date and type of surgery, and that you can't see what they'd need between 2/10 and 2/15 but "please let me know what I can get you in order to extend benefits". Start with that, I'm betting you may get an automatic "oops" extension. Also, call your surgeon's office and ask them to fax to the disability company a one page note that says "Tatiyana (last name) is scheduled for surgery 2/15/10. We will be doing a "(surgical description)".

    And I can tell you from experience, be as sweet as you can "Oh, I'm sorry, I think maybe something is missing in your system or in your information......" in your discussion. The sooner people escalated with anger the harder it was for us to get to a resolution.

    In most cases you can be approved for 6-8 weeks after an ACDF (most disability carriers use a set of guidelines that says "x" surgery requires a minimum of "y" weeks". At around week 3 if you do not think you'll be going back to work at week 6 post-op then start working with your doctor for him/her to put together objective medical information to send to the insurance carrier.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • This is helpful to know I am not the only one that has had to go through this.

    I really think that my case manager just doesnt like the fact that my surgery was scheduled so far out..

    I called my primary today since he was the last Dr visit I had (and he was the one who initially wrote me off work)and they have not gotten back to me..I think I will call the surgeon's office tomorrow but I havent seen him since we scheduled surgery in mid November.

    This is all so confusing!!
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