Guest guest Posted July 26, 2006 Report Share Posted July 26, 2006 Is this right Ginger? I am not really sure about that, Peggy. The run around they told the Coalition was it was "stuck" in case management. But the Coalition said if the insurance approved it, it none of the managements buisness. Case management called me today and told me about the clause. She said she talked to "Kathy" at the insurance. I told her I talked to "Sandy" and the Coalition had spoke to "Sandy"...and we were both told the insurance would place this under major medical and pay 100%. She said that the clause stopped them from paying for it. And she said they knew nothing of such a law. So she decided she would call "Sandy" herself. So I am waiting for her to call me back. Have waited all day. What I don't understand is when they were going to pay 80% of the actimmune cost, the clause did not matter, but now that they have committed to pay 100%, now the clause is of great concern and must be followed. Hopefully tomorrow will bring some clarification to everything. I know I will be on the phone bright and early demanding some answers. The coalition advised me I should not talk to case management any more...as they work for the insurance company and if they start agreeing to pay for this and that, they are not saving the insurance company any money. There fore the insurance company will use another company for managing their cases. Their whole reason is to save the insurance $$$$. I appreciate all the prayers today, I was a complete basket case...cried till I made myself sick. But this afternoon a warmth and peace washed over me and felt the Hand of the Man that stilled the waters. Lest we forget, He is our Great Physician and Comforter. I love you all. kiss kiss, ~Ginger~ 9/04 IPF Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 26, 2006 Report Share Posted July 26, 2006 I am a little confused.. Isn't the question or problem Ginger has with the Insurance Co.?? I too found the article on meds. for terminal illnesses but when I re-read Gingers post I think I miss understood.. The Insurance Co. is the culprit right? Is this right Ginger? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 26, 2006 Report Share Posted July 26, 2006 " JOY COMES IN THE MORNING " Peggy 09/04 ipf > > In a message dated 7/26/2006 10:13:24 PM Central Daylight Time, > pac1773@... writes: > > Is this right Ginger? > > > > > I am not really sure about that, Peggy. The run around they told the > Coalition was it was " stuck " in case management. But the Coalition said if > the > insurance approved it, it none of the managements buisness. Case management > called > me today and told me about the clause. She said she talked to " Kathy " at the > insurance. I told her I talked to " Sandy " and the Coalition had spoke to > " Sandy " ...and we were both told the insurance would place this under major > medical and pay 100%. She said that the clause stopped them from paying for > it. > And she said they knew nothing of such a law. So she decided she would call > " Sandy " herself. So I am waiting for her to call me back. Have waited all > day. > What I don't understand is when they were going to pay 80% of the actimmune > cost, the clause did not matter, but now that they have committed to pay > 100%, > now the clause is of great concern and must be followed. Hopefully tomorrow > will bring some clarification to everything. I know I will be on the phone > bright and early demanding some answers. The coalition advised me I should > not > talk to case management any more...as they work for the insurance company and > if they start agreeing to pay for this and that, they are not saving the > insurance company any money. There fore the insurance company will use > another > company for managing their cases. Their whole reason is to save the insurance > $$$$. > I appreciate all the prayers today, I was a complete basket case...cried > till I made myself sick. But this afternoon a warmth and peace washed over > me and felt the Hand of the Man that stilled the waters. Lest we forget, He > is > our Great Physician and Comforter. I love you all. > kiss kiss, > ~Ginger~ > 9/04 IPF > Quote Link to comment Share on other sites More sharing options...
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