Welcome, Friend!

It looks like you're new here. If you want to get involved, click one of these buttons!

Veritas-Health LLC has recently released patient forums to our Arthritis-Health web site.

Please visit http://www.arthritis-health.com/forum

There are several patient story videos on Spine-Health that talk about Arthritis. Search on Patient stories
Protect anonymity
We strongly suggest that members do not include their email addresses. Once that is published , your email address is available to anyone on the internet , including hackers.

All discussions and comments that contain an external URL will be automatically moved to the spam queue. No external URL pointing to a medical web site is permitted. Forum rules also indicate that you need prior moderator approval. If you are going to post an external URL, contact one of the moderators to get their approval.
Attention New Members
Your initial discussion or comment automatically is sent to a moderator's approval queue before it can be published.
There are no medical professionals on this forum side of the site. Therefore, no one is capable or permitted to provide any type of medical advice.
This includes any analysis, interpretation, or advice based on any diagnostic test

Navigating multiple insurance's and 3rd party claim.....

JulieAJJulieA Posts: 1,420
edited 06/11/2012 - 8:56 AM in Health Insurance Issues
I finally have a new appt with an attorney (I hope he is the one and he takes my case).

History: Personal Health Insurance and secondary health insurance, auto insurance (no med pay) and 3rd party auto insurance (will settle eventually but haven't paid a dime yet).

I have a history of spine problems and was T-boned by a young driver April 27th,2010.

My car was driveable and I drove my friends to their hotel and then home to wait for my husband who took me to the hospital for x-rays (I was 8 weeks out from cervical fusion). I had serious spasms in my back but they wrote it off as whiplash and to follow up with my NS.

I had appt scheduled the following week (if I remember right). I saw the NS PA and she thought I would be fine just delayed fusion and whiplash. I continued taking my painmeds and saw her again in 6 weeks.

At that point my car was fixed and I was still in pain. I begged for ESI/Nerve Block and they sent me for one. They then decided to send me to PM (same doc who did the first block. PM was good for me. They got my pain under control eventually. I had finally had my first Thoracic MRI showed lots of damage. I had 3 more ESI type injections with out great results. I also have a CT with Myelgram.

Saw the NS again and he said Thoracic fusion when I can't take it any longer (This is about December). Continued in PM. Looking at options - no SCS or Pain Pump yet.

Now we are into Spring. Pain is out of control again. Upped my meds, saw NS. Try tol hold off on surgery. X-rays neck to check my PLL. That is okay.

Now we are into summer NS wants me to have EMG for my neck... I say no. That is not the problem. I go to appt and they order new MRI- further damage at t-spine. At this point I am now having numbness in my left thigh, burning stinging, itching etc. There is constant 24 hour pain in my upper back and numbness in my back and pain reaching undermy arms into my chest and lots of nausea :)

Second opinion NS suggesting XLIF at T7/8 after new ESI to double check T7/8. Old NS suggest Tranthoracic discectomy & fusion with hardware and agrees new ESI while waiting for surgery. Tells me to get on the schedule if I decide on procedure.

In the meantime I have been contacting personal injury attorney after personal injury attorney. No one is interested in my case due to the fact that I may have had pre-existing injury of T-spine (DDD) and my other spine surgery history. Medical insurance isn't paying (wont pay unless ordered to do so by some one) They tell me to hire attorney &&&&&& DUH I am trying &&&&&.

I actually have an appt next Thursday with someone (crossing my fingers & holding my breath).

Today I get a call from my PM office staing they wont give me another ESI unless I pay 30% of my bill ($660)I am already on a payment plan giving them $100 monthly in good faith.... I owe them $25,000 already.The gal did say if the attorney takes the case and has the appropriate lien filed then it may be ok.

I owe another $13,000 to various imaging places around town. I have to pay my NS in full for each visit. I have paid them about $2,000 since the accident. I have spent about $600 on pain meds. Thank God my prescription coverage hassn't been denied.

If I have the fusion I will be out of work for 2-6 months (may never get to go back). I will be hospitalized for 3-7 days and it will cost more than $250,000 (surgery & hospital staff etc). My PLIF was $264,000 for 5 days I am going by the cost of that.

My life revolves around this nightmare. It seems completely unfair to me that I have to go through all of this when I was injured by some one else. I have pretty good insurance coverage- never have had to pay any money for anything. I am not prepared financially for this.

Please some one tell me it will be okay. I feel completley overwhelmed with the stress of this. If anyone knows of any links that help people navigate the insurance industry please send them to me.

Also I want to encourage all of you to make sure you have med-pay coverage on your auto insurance. I wish I was more educated where insurance is concerned, I would have been better off.

Thanks for any input.



  • Hi; and sorry that you are having to go thru all this.

    Since they are saying you bad pre-existing conditions, and you did'nt have medical coverage on your insurance. Did you have uninsured, or underinsured coverage.
    If so you should be able to sue yourself, for your injuries, up to your coverage limits.

    Sounds funny but thats what that insurance is there for. So good luck to ya, and i hope you find a lawyer who is willing to take your case, and find a way to make it work for ya.
  • I wish it was that easy. It should be since I have 4 insurances that can or should pay for it. I guess that is the problem (if I was only hit with out health insurance then they wouldn't be fighting over who has to pay what).

    I see the attorney this Thursday and I am hoping he will take my case. I have double health insurance.... My auto insurance does not cover medical treatments, but the at fault drivers auto insurance does cover some/all (when we settle). The attorney will go over my auto insurance with a fine tooth comb (if he takes my case). I am sure if he can find some money he will :)

    I think an attorney can get some leins/paperwork in place so that my health inbsurances will pay and then they will get paid back when the auto insurance settles.... At least the is what I am getting out of it so far.

    I am so tired of dealing with this. It is like a full time job and since I already have one, and a family to take care of this is one headache I don't need.


  • I met with a very nice attorney yesterday. He explained that I shouldn't have to pay a dime. He isn't sure if he will take my case yet. He needs to see my NS records, but my NS has my file and hasn't given it to the gal who makes the copies..... I have called like 4 times- I have been waiting for a couple weeks already...

    So the attorney is going to send a letter to my health insurances and find out why they haven't paid. Basically he says they are forciing me to hire an attorney so they will get their money back from Geico (he will have to do all the work).

    He advises that as soon as he gets this letter out he will cc me a copy that I need to contact my employer at that time. I need to tell them about my injury (my boss knows but he isn't the owner). I am supposed to ask them to push the insurance company to get my bills paid.

    He says if we go to trial I could loose and end up paying all fo their attorney fee's.... Wouldn't be so great. He said the jury can award for three things, medical expenses, ecomonic expenses, and non economic (pain & suffering). Since I haven't taken any time off then I wouldn't have a good case for that. I explained that when I have the surgery I will be off for 4-6 months and that I may never get to go back. He said that changes everything.

    I am going to see him in about 10 days (if I can collect my file). At that point I would sign a contract and we would discuss the strategy). He explained there really isn't that much money in auto accidents. I don't even care at this point I just want my medical bills paid.

    I am supposed to have another CT Scan with Myelogram per my NS (before I go on with any more ESI's). I haven't been called on that yet so I am not sure if my credit limits at all the imaging centers is maxed out. At this point my treatmenst are on hold untill someone releases some money.

  • Sad; that you have to go thru all of this.
    If we are a few days late making the ins. co. payment they are calling us, but when its time for them to pay, they like pointing the finger at someone else.

    Hopefully this lawyer will take your case, and get all this fixed for you, so you can get the medical care you need without getting the bills for it.
    Auto ins. is all about who's at fault, and what %, also what is covered and the policy limits.

    Best of luck to ya, and i hope it all gets resolved for ya.
  • I wanted to update this thread, I haven't signed the attorney yet. He is still reviewing my case before he decides if he is going to take it.

    He did however write my personal health insurance the primary and started some dialog with them. They have now officially paid $12,000 of the bills (not sent the checks but started the payment process). They also state that they may pay more of it. I have close to $35,000 total at this point. I have another $23,000 that needs to be paid. I am so happy there is movement in the right direction....

    I can't believe with just a little fishing on his behalf they started paying. Of course whatever settlement Geico offers will be subject to repayment of my medical expenses to the Personal Health Insurances but at least I feel like I can breath now.

    Now I can continue getting treatments at least.

  • Thats good news.
    I know you had a sigh of relief.

    Dont worry about the Gecko, he has deep pockets. lol
  • I wanted to update this thread. I haven't been on here in some time.

    I did sign the attorney and he has already met with my NS and PM.

    Insurance still has not paid a single red cent. My treatment has been on hold since October. I am waiting for more ESI's and a SCS trial.

    I am pretty much bedridden now. My days consist of moving from my recliner to my computer (where I work) and back to my recliner (w/heating pad or ice packs). I never want to go any where let alone grocery shop. There are tons of projects adding up.

    I am still working since I can't afford not to. I was given a Perm Disability Parking Permit & told I will only get worse about 2 months ago :) Just folding a load of laundry sets me into a terrible bunch of spasms.

    My life is a mess.

  • SpineAZSpineAZ WiscPosts: 1,084
    Does your employer offer any kind of Short Term Disability or Long Term Disability benefits? Without STD and LTD I don't know what I would have done.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
  • Been wondering where you went. Havent seen you here in awhile.
    Anyway sorry to hear about your continualing(sp) bad luck.
    Cant offer you any advice, except to keep on the lawyer telling him you need ins. co. help like now.

    best of luck to ya, and hope you dont live in Nome those people really are getting socked in.
  • Update. Today the lizard offered a settlement> more than I make in a year but not enough IMHO. I owe over half that in medical bills and it is still going. Plus the attorney is going to take 33% so it would basically be just enough to make me current with my medical bills and the injections that I am having tomorrow (yes) you heard right I am finally moving forward with the TFESI that I need prior to a SCS trial.

    So that is good news. I guess it is normal to offer low ball settlements. We were preparing to file suite very shortly. We may still but at least we know they want to play ball.

    Bad new is I am starting to loose the use of my left arm. It started as just aches and has rapidly turned into a big problem. My upper back pain is really been turned up lately too- it never seems to give me a break any more always hovering arounf 6-8 in tears more often than not. I called my PM's nurse after a med change and never recieved a call back so when I see them tomorrow will give them an ear full.

    I hope the esi helps because I can not go on like this... I am afraid to tell my NS but I will be talking to them next week after my esi to schedule an office visit. My PM had thought it was just a flare, but this week I have lost it several times :(

    It is uncomfortable to stay on the computer very long. That is why I have been MIA.

    Thanks for the support :)

  • Your 1st paragraph says it all'
    By the time the doctors and lawyer get their share, the person who is in pain and suffered does'nt get a damn thing. Not one penny left over for your hardship.
    Unfortunally thats the way the laws are written and theres not a thing you can do about it.

    My brother went thru the same thing as you are now going thru but his was'nt near as bad as yours.
    He was on a bicycle and was hit by a drunk driver, and my brother wound up with 8 broken ribs and a collapased lung. He had a 8 day hospital and when it was all over with he got only $5000 thousand.
    That did'nt even cover his lost time at work.

    So best of luck to ya, and dont rush yourself into taking money until your sure thats all you can get out of them.

  • I would sue and not settle. If you lose just go bankrupt. I settled and now feel that I should've gone big or go down in flames. I pray that my settlement can cover my new bills that will not be paid. I am looking into the pre existing insurance plan run by the government and hope that it is legit or I'm so screwed.
  • JulieAJJulieA Posts: 1,420
    edited 09/24/2012 - 7:27 AM
    I wanted to update that my case has settled the full amount allowed by law with both auto insurances last Saturday( at fault driver as well my personal insurance).
    The reason why we chose not to go to court is that it is risky and due to my pre existing spine problems (extensive DDD & multiple fusions), we were afraid they may find in favor of the insurance companies and I would loose everything. I did finally get enough to pay off the bills & then some. My personal health insurance started paying all my medical bills 100 percent immediately after it settled.
    I am glad it is over with. I can only recommend that if any of you have any kind if accident (work or auto) and you are seriously injured, please do yourself a favor and don't wait. Hire an attorney as soon as you can. Yes they do take part of your settlement, but it is so worth it to have some one navigate it for you.
Sign In or Register to comment.