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I spoke to soon!!!!!!!!!!!!!! UPDATED AGAIN

iowarobiniiowarobin Posts: 1,268
edited 06/11/2012 - 8:48 AM in Back Surgery and Neck Surgery
Ok, I get approval for sugery on Dec 13. Yeah, right! Well, I got approval for out of network surgery with a $20,000.00 deductible...Not what I thought.
So now, the insurance co wants my surgeon to call and tell them why they should pay it in network, even though they paid it in network in Dec 2008 for surgery in Mn also. I cant have it done in network, because, just like last time, no one in Iowa could figure out what was wrong. So you would think that looking back at same surgery, just different levels, it would be a no brainer!
No they are just there to drive me off the flipping edge, I dont know what else to do. Calgon take me away!!!!

Ok, I know God doesnt give us more than we can take, but this AM my Dad passed away after a stroke left him paralized on one side, two years ago, a week after my first fusion. I am so stressed right now....


  • Boy I hate that you are having such a bad time. Now you have an aching back and a crazy insurance company. What a mix. Take a deep breath and think about what you can do to get them to understand that the insurance company will need to pay in network because no one has the ability to do it that are in network. I will pray that somehow the insurance will "understand" their responsibility in this matter. Try to relax tonight and get back out tommorrow and fight for YOUR HEALTH!!! This is important. Soft hugs....
  • Just wanted you to know that I am praying hard that this company will work with you to regain your health and retain you money.

    Much luck!!!

  • that you are having such trouble. It is awful. But think of this way...you have some type of insurance which I thank God for all the time since I read all the posts on here from those who don't. Scary! Hang in there...it will come together. I just got my surgery bills (hospital and Dr only so far) and it going to kill my budget (the whopping 10% I have to pay) for a while.


  • I hope you can get this all worked out before the 13th and that everything will go just fine. Insurance companies are enough to drive you round the bend.
    3 level spinal fusion, L3/4, L4/5, L5/S1, November 2008. Stiff, but I can walk.
  • Another option is to negotiate with the doctor.
    I had my 1st surgery out of network b/c I was somewhat urgent and the doctor I trusted was the one recommended by my GP and that my Mom had used.

    I told them I was worried about cost. They asked me what my out-of-network fee was and luckily at the time I was on a co-pay plan so I told them. They said, fine, that is all we will charge you. We'll work everything else out with the insurance company.

    Not sure if it's an option but you could talk to the office and see if you can write a hard-ship letter to get a reduced fee. That seems insane.
  • I updated my first post. Sorry
  • To you on your tragic loss and I will say a prayer that your insurance company remembers that you are are way more than just a number!
  • My deepest sympathy on the passing of your father >:D<
    You are in my thoughts. I hope for a quick resolution with your insurance company, you have been through more than enough
    >:D< Karen
    >:D< >:-D< : Karen
    L3-S1 herniation and bulges, stenosis, mod facet,ddd,impinged nerves,coccydinia
    discectomy/lami July 2011-unsuccessful
    adr L5-S1 Feb 2012
  • I'm so sorry to hear about your Father passing away. Thinking of you at this time and hope this insurance gets worked out for you. 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 am so so sorry :hug: Prayers remain
    L1 - S2 "gone" useless in 1 way or another. DDD. RA. Bone Spurs. Tons of nerve damage/issues. Stenosis. Both knees replaced. 50 yrs old. I had a great fall (hence my user name) at age 41 and it has been a domino effect every since.
  • Condolences for you and your family. So sorry to hear of this loss. Big support *HUGZ* for you and yours!!

    Fingers remained crossed that the insurance issue will get cleared up soon.

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • jlrfryejjlrfrye ohioPosts: 1,110
    Your insurance will pay out of network benefits if there is not a physician within certain miles of you ( look at your contract) that cannot help you. Read the fine print of the contract and then call your insurance company. Once again tell them that they are preventing you from care and causing possible irreversable damage by delaying the surgery. Refuse to speak to anyone but a supervisor. Tell the supervisor about the run around you have been given and are at the point of seeking legal council. Most insurance companies hope that people will accept what they are told and just pay the bill. Be assertive and dont hang up the phone until you have a approval with a approval number for the surgery.Good luck
    Its bad enough the stress we go through to have surgery but then add the stress of dealing with insurance companies it is a wonder we all do not have nervous breakdowns.
    If they want something in writing from you ask for the supervisors direct fax number and request that you be called within 24 hours of the conversation.
  • im sorry to here of your loss, my condolences to you and your family
    i do hope your insurance issues resolve soon, you certainly dont need that hassel

    take care
  • I'm so sorry to hear about your dad. I hope eventually you will be at peace with his passing and will just have the wonderful memories of him in your life. I lost both my parents when I was 12. There's just never a good time for this to happen. God bless you and give you peace.
    3 level spinal fusion, L3/4, L4/5, L5/S1, November 2008. Stiff, but I can walk.

  • I am so sorry for the loss of your father. I am praying for you and your family. >:D<
    I hope very soon that the happy memories of your dad will help with the sadness.

    I also hope that your surgeon manages to convince your insurance company that they need to pass this for your surgery.

    You are going through a very tough time right now.
    You have a lot of spiney friends here that are cheering you on and praying for you. :-)
  • I'm very sorry to hear about you losing your Dad.
    My thought's and prayer's for you and your family.
  • I would also contact the insurance commissioner of your state. They have more influence than anyone on the insurance company. Without the blessings of the insurance commissioner, an insurance company can't do business within the state. the insurance commissioner is responsible for seeing that they uphold the contract and that the contract is reasonable. Sometimes just a word from their office can turn the tables.
  • Just want you to know that I'm so sorry about the loss of your dad. And on top of it all, dealing with insurance and your health and the holidays, ugghhhh! I hope things work out soon.


  • stopping in to see how you are doing :hug:
    L1 - S2 "gone" useless in 1 way or another. DDD. RA. Bone Spurs. Tons of nerve damage/issues. Stenosis. Both knees replaced. 50 yrs old. I had a great fall (hence my user name) at age 41 and it has been a domino effect every since.
  • I am so sorry to read about your loss.

    My thoughts and prayers are with you (always are)during this difficult time.

    Hugs with love,

    Tammy >:D<
  • How you bear up under the stress of it all is beyond my imagination! Sending up prayers for God to give you the strength to persevere through all the trials you are being given. So sorry to hear of your dad's passing....it's so hard....I just know that you'll get this situation corrected with the insurance company and the "out of network" business.

    I know when I'm in pain it's so hard to deal with anything but the basics of everyday life so I feel for you as you try to deal with your insurance issues and the pain at the same time.

    Big >:D< >:D< >:D< to you sweetie...

    Thinking of you,

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