Guest guest Posted March 10, 2003 Report Share Posted March 10, 2003 After 2 1/2 months of waiting, my insurance turned me down for resurf as it is not FDA approved. I am really mad because, according to my doc, this same insurance has paid for several resurfs in the past with no hassle. I feel like I am being discriminated against and don't look forward to limping around in pain waiting for the FDA to do their thing as I do not want a shank of steel down my femur with a regular replacement. Has anyone else had this happen (if you feel OK to share)? If so, did filing for a " reconsideration " do any good? Thanks, this is a great group. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 10, 2003 Report Share Posted March 10, 2003 As I have previously noted: 1. The coverage depends upon the exact wording of your insurance contract as spelled out in the " Plan Policy " . This has more to do with contract law than medicine. 2. Depending upon your state, there are appeal rights through the company and often through the state insurance office/ commissioner. 3. Some people have had sucessful appeals, others not. You may be able to arrange a negotiated compromise for coverage. 4. For the appeals process you may need to consult an attorney. This should be someone with experience with contract/health law. The average local attorney who handles real estate and traffic violations can not do this. They may be able to recommend someone who can help. 5. Negotiate a fee schedule up front with the attorney. Don't be bashful, it's your money. The whole thing should not take more than 10-12 hours of professional fees if you do your homework first. Collect the documents. This will save the attorney time, and you money. The wording of the plan is critical. Who is the real insurance Company? Who is the administrator of the plan? A. The Drs. letter supporting and requesting resurfacing for you. B. Your insurance plan documents. C. The denial letter and any associated documents. Some insurance plans have pre-prepared policies on resurfacing or other " investigational " procedures. D. Other support letters (from a referring FP or other primary care .) E. background information on M-O-M resurfacing from the surface hippy, activejoints.com and other sites The insurance plan may have conflicting policies regarding " Devices " , prosthetic joints, separation of coverage for different parts of the surgery, " medical necessity " and other factors. That is why you need legal expertise. MOST OS OFFICES CAN NOT HELP YOU WITH AN APPEAL. If you are in North Carolina I could recommend an attorney, but not in other states. (MD) in NC -- In surfacehippy , " jackvz2000 " <jackvz2000@y...> wrote: > After 2 1/2 months of waiting, my insurance turned me down for resurf > as it is not FDA approved. I am really mad because, according to my > doc, this same insurance has paid for several resurfs in the past > with no hassle. I feel like I am being discriminated against and > don't look forward to limping around in pain waiting for the FDA to > do their thing as I do not want a shank of steel down my femur with a > regular replacement. Has anyone else had this happen (if you feel OK > to share)? If so, did filing for a " reconsideration " do any good? > Thanks, this is a great group. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 10, 2003 Report Share Posted March 10, 2003 As I have previously noted: 1. The coverage depends upon the exact wording of your insurance contract as spelled out in the " Plan Policy " . This has more to do with contract law than medicine. 2. Depending upon your state, there are appeal rights through the company and often through the state insurance office/ commissioner. 3. Some people have had sucessful appeals, others not. You may be able to arrange a negotiated compromise for coverage. 4. For the appeals process you may need to consult an attorney. This should be someone with experience with contract/health law. The average local attorney who handles real estate and traffic violations can not do this. They may be able to recommend someone who can help. 5. Negotiate a fee schedule up front with the attorney. Don't be bashful, it's your money. The whole thing should not take more than 10-12 hours of professional fees if you do your homework first. Collect the documents. This will save the attorney time, and you money. The wording of the plan is critical. Who is the real insurance Company? Who is the administrator of the plan? A. The Drs. letter supporting and requesting resurfacing for you. B. Your insurance plan documents. C. The denial letter and any associated documents. Some insurance plans have pre-prepared policies on resurfacing or other " investigational " procedures. D. Other support letters (from a referring FP or other primary care .) E. background information on M-O-M resurfacing from the surface hippy, activejoints.com and other sites The insurance plan may have conflicting policies regarding " Devices " , prosthetic joints, separation of coverage for different parts of the surgery, " medical necessity " and other factors. That is why you need legal expertise. MOST OS OFFICES CAN NOT HELP YOU WITH AN APPEAL. If you are in North Carolina I could recommend an attorney, but not in other states. (MD) in NC -- In surfacehippy , " jackvz2000 " <jackvz2000@y...> wrote: > After 2 1/2 months of waiting, my insurance turned me down for resurf > as it is not FDA approved. I am really mad because, according to my > doc, this same insurance has paid for several resurfs in the past > with no hassle. I feel like I am being discriminated against and > don't look forward to limping around in pain waiting for the FDA to > do their thing as I do not want a shank of steel down my femur with a > regular replacement. Has anyone else had this happen (if you feel OK > to share)? If so, did filing for a " reconsideration " do any good? > Thanks, this is a great group. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 10, 2003 Report Share Posted March 10, 2003 I don't know if this will help... As I researched further into the resurf process and learned that not all insurance paid for the procedure, I mentally planned my appeals. One of my thoughts was that the ol' squeaky wheel gets the grease - and I was going to send off a barrage of letters to our Press, my Senators and Reps - (you get the picture) howling how unfair it was for my insurance to demand that my perfectly healthy bone be amputated, etc. Turns out my insurance paid, and I'm a happy camper. Best wishes to you in your battle! Deb > After 2 1/2 months of waiting, my insurance turned me down for resurf > as it is not FDA approved. I am really mad because, according to my > doc, this same insurance has paid for several resurfs in the past > with no hassle. I feel like I am being discriminated against and > don't look forward to limping around in pain waiting for the FDA to > do their thing as I do not want a shank of steel down my femur with a > regular replacement. Has anyone else had this happen (if you feel OK > to share)? If so, did filing for a " reconsideration " do any good? > Thanks, this is a great group. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 10, 2003 Report Share Posted March 10, 2003 I don't know if this will help... As I researched further into the resurf process and learned that not all insurance paid for the procedure, I mentally planned my appeals. One of my thoughts was that the ol' squeaky wheel gets the grease - and I was going to send off a barrage of letters to our Press, my Senators and Reps - (you get the picture) howling how unfair it was for my insurance to demand that my perfectly healthy bone be amputated, etc. Turns out my insurance paid, and I'm a happy camper. Best wishes to you in your battle! Deb > After 2 1/2 months of waiting, my insurance turned me down for resurf > as it is not FDA approved. I am really mad because, according to my > doc, this same insurance has paid for several resurfs in the past > with no hassle. I feel like I am being discriminated against and > don't look forward to limping around in pain waiting for the FDA to > do their thing as I do not want a shank of steel down my femur with a > regular replacement. Has anyone else had this happen (if you feel OK > to share)? If so, did filing for a " reconsideration " do any good? > Thanks, this is a great group. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 10, 2003 Report Share Posted March 10, 2003 Thanks for your good information, the doc's nurse said there is an appeal process that they will handle. But, if that fails I will surely raise hell where ever and when ever. Again, thanks. - In surfacehippy , " gimpymommi " <nothip@a...> wrote: > I don't know if this will help... > > As I researched further into the resurf process and learned that not > all insurance paid for the procedure, I mentally planned my > appeals. One of my thoughts was that the ol' squeaky wheel gets the > grease - and I was going to send off a barrage of letters to our > Press, my Senators and Reps - (you get the picture) howling how > unfair it was for my insurance to demand that my perfectly healthy > bone be amputated, etc. > > Turns out my insurance paid, and I'm a happy camper. > > Best wishes to you in your battle! > > Deb > > > > > After 2 1/2 months of waiting, my insurance turned me down for > resurf > > as it is not FDA approved. I am really mad because, according to > my > > doc, this same insurance has paid for several resurfs in the past > > with no hassle. I feel like I am being discriminated against and > > don't look forward to limping around in pain waiting for the FDA > to > > do their thing as I do not want a shank of steel down my femur > with a > > regular replacement. Has anyone else had this happen (if you feel > OK > > to share)? If so, did filing for a " reconsideration " do any good? > > Thanks, this is a great group. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 10, 2003 Report Share Posted March 10, 2003 Thanks for your good information, the doc's nurse said there is an appeal process that they will handle. But, if that fails I will surely raise hell where ever and when ever. Again, thanks. - In surfacehippy , " gimpymommi " <nothip@a...> wrote: > I don't know if this will help... > > As I researched further into the resurf process and learned that not > all insurance paid for the procedure, I mentally planned my > appeals. One of my thoughts was that the ol' squeaky wheel gets the > grease - and I was going to send off a barrage of letters to our > Press, my Senators and Reps - (you get the picture) howling how > unfair it was for my insurance to demand that my perfectly healthy > bone be amputated, etc. > > Turns out my insurance paid, and I'm a happy camper. > > Best wishes to you in your battle! > > Deb > > > > > After 2 1/2 months of waiting, my insurance turned me down for > resurf > > as it is not FDA approved. I am really mad because, according to > my > > doc, this same insurance has paid for several resurfs in the past > > with no hassle. I feel like I am being discriminated against and > > don't look forward to limping around in pain waiting for the FDA > to > > do their thing as I do not want a shank of steel down my femur > with a > > regular replacement. Has anyone else had this happen (if you feel > OK > > to share)? If so, did filing for a " reconsideration " do any good? > > Thanks, this is a great group. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 10, 2003 Report Share Posted March 10, 2003 Thanks for your good information, the doc's nurse said there is an appeal process that they will handle. But, if that fails I will surely raise hell where ever and when ever. Again, thanks. - In surfacehippy , " gimpymommi " <nothip@a...> wrote: > I don't know if this will help... > > As I researched further into the resurf process and learned that not > all insurance paid for the procedure, I mentally planned my > appeals. One of my thoughts was that the ol' squeaky wheel gets the > grease - and I was going to send off a barrage of letters to our > Press, my Senators and Reps - (you get the picture) howling how > unfair it was for my insurance to demand that my perfectly healthy > bone be amputated, etc. > > Turns out my insurance paid, and I'm a happy camper. > > Best wishes to you in your battle! > > Deb > > > > > After 2 1/2 months of waiting, my insurance turned me down for > resurf > > as it is not FDA approved. I am really mad because, according to > my > > doc, this same insurance has paid for several resurfs in the past > > with no hassle. I feel like I am being discriminated against and > > don't look forward to limping around in pain waiting for the FDA > to > > do their thing as I do not want a shank of steel down my femur > with a > > regular replacement. Has anyone else had this happen (if you feel > OK > > to share)? If so, did filing for a " reconsideration " do any good? > > Thanks, this is a great group. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 11, 2003 Report Share Posted March 11, 2003 I understand your frustration ... been there ... fought and won. Remember - not all policies issued by a provider are the same. You have to review your policy cover to cover ... look for a loophole. My policy did not cover experimental or investigative proceedures BUT it did allow the Medical Director to provide an override. I found that information in the glossary - while looking up their definition of experimental and investigative. There are so many different policies that most likely the clerk your talking to will not know every aspect of your policy. Be calm and polite to all you speak with ... not easy ... like I said ... I've been there. You need to win them to your side ... you need their help. Feel free to email me privately. jackvz2000 wrote:After 2 1/2 months of waiting, my insurance turned me down for resurf as it is not FDA approved. I am really mad because, according to my doc, this same insurance has paid for several resurfs in the past with no hassle. I feel like I am being discriminated against and don't look forward to limping around in pain waiting for the FDA to do their thing as I do not want a shank of steel down my femur with a regular replacement. Has anyone else had this happen (if you feel OK to share)? If so, did filing for a " reconsideration " do any good? Thanks, this is a great group. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 11, 2003 Report Share Posted March 11, 2003 I understand your frustration ... been there ... fought and won. Remember - not all policies issued by a provider are the same. You have to review your policy cover to cover ... look for a loophole. My policy did not cover experimental or investigative proceedures BUT it did allow the Medical Director to provide an override. I found that information in the glossary - while looking up their definition of experimental and investigative. There are so many different policies that most likely the clerk your talking to will not know every aspect of your policy. Be calm and polite to all you speak with ... not easy ... like I said ... I've been there. You need to win them to your side ... you need their help. Feel free to email me privately. jackvz2000 wrote:After 2 1/2 months of waiting, my insurance turned me down for resurf as it is not FDA approved. I am really mad because, according to my doc, this same insurance has paid for several resurfs in the past with no hassle. I feel like I am being discriminated against and don't look forward to limping around in pain waiting for the FDA to do their thing as I do not want a shank of steel down my femur with a regular replacement. Has anyone else had this happen (if you feel OK to share)? If so, did filing for a " reconsideration " do any good? Thanks, this is a great group. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 11, 2003 Report Share Posted March 11, 2003 I understand your frustration ... been there ... fought and won. Remember - not all policies issued by a provider are the same. You have to review your policy cover to cover ... look for a loophole. My policy did not cover experimental or investigative proceedures BUT it did allow the Medical Director to provide an override. I found that information in the glossary - while looking up their definition of experimental and investigative. There are so many different policies that most likely the clerk your talking to will not know every aspect of your policy. Be calm and polite to all you speak with ... not easy ... like I said ... I've been there. You need to win them to your side ... you need their help. Feel free to email me privately. jackvz2000 wrote:After 2 1/2 months of waiting, my insurance turned me down for resurf as it is not FDA approved. I am really mad because, according to my doc, this same insurance has paid for several resurfs in the past with no hassle. I feel like I am being discriminated against and don't look forward to limping around in pain waiting for the FDA to do their thing as I do not want a shank of steel down my femur with a regular replacement. Has anyone else had this happen (if you feel OK to share)? If so, did filing for a " reconsideration " do any good? Thanks, this is a great group. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 12, 2003 Report Share Posted March 12, 2003 INSURANCE!!! I was turned down by United Health Care PPO for R/C+/Schmalzried. I was encouraged to appeal when a friends appeal worked! He sent me his letter, which was a great start place. I have now just finished my letter, complete with references to all the web sites etc. I will be glad to share these letters with those who are interested. The language of your insurance contract is the important thing. It's not about medicine, it's about contract law. (I stole that from surfacehippy) All policies are worded differently. I will post on the results of my appeal letter. CJ in Santa Cruz a C+wantabe (clatta@...) ---------- > >To: surfacehippy >Subject: Re: insurance >Date: Mon, Mar 10, 2003, 2:10 PM > >lThanks for your good information, the doc's nurse said there is an >appeal process that they will handle. But, if that fails I will >surely raise hell where ever and when ever. Again, thanks. >- In surfacehippy , " gimpymommi " <nothip@a...> wrote: >> I don't know if this will help... >> >> As I researched further into the resurf process and learned that >not >> all insurance paid for the procedure, I mentally planned my >> appeals. One of my thoughts was that the ol' squeaky wheel gets >the >> grease - and I was going to send off a barrage of letters to our >> Press, my Senators and Reps - (you get the picture) howling how >> unfair it was for my insurance to demand that my perfectly healthy >> bone be amputated, etc. >> >> Turns out my insurance paid, and I'm a happy camper. >> >> Best wishes to you in your battle! >> >> Deb >> >> >> >> > After 2 1/2 months of waiting, my insurance turned me down for >> resurf >> > as it is not FDA approved. I am really mad because, according to >> my >> > doc, this same insurance has paid for several resurfs in the past >> > with no hassle. I feel like I am being discriminated against and >> > don't look forward to limping around in pain waiting for the FDA >> to >> > do their thing as I do not want a shank of steel down my femur >> with a >> > regular replacement. Has anyone else had this happen (if you feel >> OK >> > to share)? If so, did filing for a " reconsideration " do any good? >> > Thanks, this is a great group. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 12, 2003 Report Share Posted March 12, 2003 INSURANCE!!! I was turned down by United Health Care PPO for R/C+/Schmalzried. I was encouraged to appeal when a friends appeal worked! He sent me his letter, which was a great start place. I have now just finished my letter, complete with references to all the web sites etc. I will be glad to share these letters with those who are interested. The language of your insurance contract is the important thing. It's not about medicine, it's about contract law. (I stole that from surfacehippy) All policies are worded differently. I will post on the results of my appeal letter. CJ in Santa Cruz a C+wantabe (clatta@...) ---------- > >To: surfacehippy >Subject: Re: insurance >Date: Mon, Mar 10, 2003, 2:10 PM > >lThanks for your good information, the doc's nurse said there is an >appeal process that they will handle. But, if that fails I will >surely raise hell where ever and when ever. Again, thanks. >- In surfacehippy , " gimpymommi " <nothip@a...> wrote: >> I don't know if this will help... >> >> As I researched further into the resurf process and learned that >not >> all insurance paid for the procedure, I mentally planned my >> appeals. One of my thoughts was that the ol' squeaky wheel gets >the >> grease - and I was going to send off a barrage of letters to our >> Press, my Senators and Reps - (you get the picture) howling how >> unfair it was for my insurance to demand that my perfectly healthy >> bone be amputated, etc. >> >> Turns out my insurance paid, and I'm a happy camper. >> >> Best wishes to you in your battle! >> >> Deb >> >> >> >> > After 2 1/2 months of waiting, my insurance turned me down for >> resurf >> > as it is not FDA approved. I am really mad because, according to >> my >> > doc, this same insurance has paid for several resurfs in the past >> > with no hassle. I feel like I am being discriminated against and >> > don't look forward to limping around in pain waiting for the FDA >> to >> > do their thing as I do not want a shank of steel down my femur >> with a >> > regular replacement. Has anyone else had this happen (if you feel >> OK >> > to share)? If so, did filing for a " reconsideration " do any good? >> > Thanks, this is a great group. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 13, 2003 Report Share Posted March 13, 2003 Yes, yes thank you, I would be most interested in seeing your letter. I was rejected by Uniform Medical Plan here in Washington (state) for a C+ with Sparling (Vancouver, WA). I was told by his adm. to let them handle it but am not that confident they will do a good job. Sooo, thanks in advance, it was quite a blow to receive the rejection after waiting 2 1/2 months for a decision. > >> > After 2 1/2 months of waiting, my insurance turned me down for > >> resurf > >> > as it is not FDA approved. I am really mad because, according to > >> my > >> > doc, this same insurance has paid for several resurfs in the past > >> > with no hassle. I feel like I am being discriminated against and > >> > don't look forward to limping around in pain waiting for the FDA > >> to > >> > do their thing as I do not want a shank of steel down my femur > >> with a > >> > regular replacement. Has anyone else had this happen (if you feel > >> OK > >> > to share)? If so, did filing for a " reconsideration " do any good? > >> > Thanks, this is a great group. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 13, 2003 Report Share Posted March 13, 2003 Yes, yes thank you, I would be most interested in seeing your letter. I was rejected by Uniform Medical Plan here in Washington (state) for a C+ with Sparling (Vancouver, WA). I was told by his adm. to let them handle it but am not that confident they will do a good job. Sooo, thanks in advance, it was quite a blow to receive the rejection after waiting 2 1/2 months for a decision. > >> > After 2 1/2 months of waiting, my insurance turned me down for > >> resurf > >> > as it is not FDA approved. I am really mad because, according to > >> my > >> > doc, this same insurance has paid for several resurfs in the past > >> > with no hassle. I feel like I am being discriminated against and > >> > don't look forward to limping around in pain waiting for the FDA > >> to > >> > do their thing as I do not want a shank of steel down my femur > >> with a > >> > regular replacement. Has anyone else had this happen (if you feel > >> OK > >> > to share)? If so, did filing for a " reconsideration " do any good? > >> > Thanks, this is a great group. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 13, 2003 Report Share Posted March 13, 2003 Yes, yes thank you, I would be most interested in seeing your letter. I was rejected by Uniform Medical Plan here in Washington (state) for a C+ with Sparling (Vancouver, WA). I was told by his adm. to let them handle it but am not that confident they will do a good job. Sooo, thanks in advance, it was quite a blow to receive the rejection after waiting 2 1/2 months for a decision. > >> > After 2 1/2 months of waiting, my insurance turned me down for > >> resurf > >> > as it is not FDA approved. I am really mad because, according to > >> my > >> > doc, this same insurance has paid for several resurfs in the past > >> > with no hassle. I feel like I am being discriminated against and > >> > don't look forward to limping around in pain waiting for the FDA > >> to > >> > do their thing as I do not want a shank of steel down my femur > >> with a > >> > regular replacement. Has anyone else had this happen (if you feel > >> OK > >> > to share)? If so, did filing for a " reconsideration " do any good? > >> > Thanks, this is a great group. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 13, 2003 Report Share Posted March 13, 2003 I'd love to see your letter! Thanks for sharing! Michele Re: insurance >Date: Mon, Mar 10, 2003, 2:10 PM > >lThanks for your good information, the doc's nurse said there is an >appeal process that they will handle. But, if that fails I will >surely raise hell where ever and when ever. Again, thanks. >- In surfacehippy , " gimpymommi " <nothip@a...> wrote: >> I don't know if this will help... >> >> As I researched further into the resurf process and learned that >not >> all insurance paid for the procedure, I mentally planned my >> appeals. One of my thoughts was that the ol' squeaky wheel gets >the >> grease - and I was going to send off a barrage of letters to our >> Press, my Senators and Reps - (you get the picture) howling how >> unfair it was for my insurance to demand that my perfectly healthy >> bone be amputated, etc. >> >> Turns out my insurance paid, and I'm a happy camper. >> >> Best wishes to you in your battle! >> >> Deb >> >> >> >> > After 2 1/2 months of waiting, my insurance turned me down for >> resurf >> > as it is not FDA approved. I am really mad because, according to >> my >> > doc, this same insurance has paid for several resurfs in the past >> > with no hassle. I feel like I am being discriminated against and >> > don't look forward to limping around in pain waiting for the FDA >> to >> > do their thing as I do not want a shank of steel down my femur >> with a >> > regular replacement. Has anyone else had this happen (if you feel >> OK >> > to share)? If so, did filing for a " reconsideration " do any good? >> > Thanks, this is a great group. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 13, 2003 Report Share Posted March 13, 2003 I'd love to see your letter! Thanks for sharing! Michele Re: insurance >Date: Mon, Mar 10, 2003, 2:10 PM > >lThanks for your good information, the doc's nurse said there is an >appeal process that they will handle. But, if that fails I will >surely raise hell where ever and when ever. Again, thanks. >- In surfacehippy , " gimpymommi " <nothip@a...> wrote: >> I don't know if this will help... >> >> As I researched further into the resurf process and learned that >not >> all insurance paid for the procedure, I mentally planned my >> appeals. One of my thoughts was that the ol' squeaky wheel gets >the >> grease - and I was going to send off a barrage of letters to our >> Press, my Senators and Reps - (you get the picture) howling how >> unfair it was for my insurance to demand that my perfectly healthy >> bone be amputated, etc. >> >> Turns out my insurance paid, and I'm a happy camper. >> >> Best wishes to you in your battle! >> >> Deb >> >> >> >> > After 2 1/2 months of waiting, my insurance turned me down for >> resurf >> > as it is not FDA approved. I am really mad because, according to >> my >> > doc, this same insurance has paid for several resurfs in the past >> > with no hassle. I feel like I am being discriminated against and >> > don't look forward to limping around in pain waiting for the FDA >> to >> > do their thing as I do not want a shank of steel down my femur >> with a >> > regular replacement. Has anyone else had this happen (if you feel >> OK >> > to share)? If so, did filing for a " reconsideration " do any good? >> > Thanks, this is a great group. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 13, 2003 Report Share Posted March 13, 2003 I'd love to see your letter! Thanks for sharing! Michele Re: insurance >Date: Mon, Mar 10, 2003, 2:10 PM > >lThanks for your good information, the doc's nurse said there is an >appeal process that they will handle. But, if that fails I will >surely raise hell where ever and when ever. Again, thanks. >- In surfacehippy , " gimpymommi " <nothip@a...> wrote: >> I don't know if this will help... >> >> As I researched further into the resurf process and learned that >not >> all insurance paid for the procedure, I mentally planned my >> appeals. One of my thoughts was that the ol' squeaky wheel gets >the >> grease - and I was going to send off a barrage of letters to our >> Press, my Senators and Reps - (you get the picture) howling how >> unfair it was for my insurance to demand that my perfectly healthy >> bone be amputated, etc. >> >> Turns out my insurance paid, and I'm a happy camper. >> >> Best wishes to you in your battle! >> >> Deb >> >> >> >> > After 2 1/2 months of waiting, my insurance turned me down for >> resurf >> > as it is not FDA approved. I am really mad because, according to >> my >> > doc, this same insurance has paid for several resurfs in the past >> > with no hassle. I feel like I am being discriminated against and >> > don't look forward to limping around in pain waiting for the FDA >> to >> > do their thing as I do not want a shank of steel down my femur >> with a >> > regular replacement. Has anyone else had this happen (if you feel >> OK >> > to share)? If so, did filing for a " reconsideration " do any good? >> > Thanks, this is a great group. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 13, 2003 Report Share Posted March 13, 2003 > INSURANCE!!! > > The language of your insurance contract is the important thing. It's not > about medicine, it's about contract law. (I stole that from surfacehippy) > All policies are worded differently. > > I will post on the results of my appeal letter. > > CJ in Santa Cruz a C+wantabe (clatta@c...) CJ, You are soooo right! My approval came down to two words in my contract: " medically necessary " . Look for those words and see how all is worded around it. Even though what I wanted was " investigational " and denied, it was found to be medically necessary for me and therefore approved. I did have enough info in my favor to show it was medically necessary and I also had the " right " person reading all this. Go for it! BUT, I was told by a lawyer that you need at least two to three medical opinions in your favor to do this. The more the merrier. Trudy Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 13, 2003 Report Share Posted March 13, 2003 > INSURANCE!!! > > The language of your insurance contract is the important thing. It's not > about medicine, it's about contract law. (I stole that from surfacehippy) > All policies are worded differently. > > I will post on the results of my appeal letter. > > CJ in Santa Cruz a C+wantabe (clatta@c...) CJ, You are soooo right! My approval came down to two words in my contract: " medically necessary " . Look for those words and see how all is worded around it. Even though what I wanted was " investigational " and denied, it was found to be medically necessary for me and therefore approved. I did have enough info in my favor to show it was medically necessary and I also had the " right " person reading all this. Go for it! BUT, I was told by a lawyer that you need at least two to three medical opinions in your favor to do this. The more the merrier. Trudy Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 13, 2003 Report Share Posted March 13, 2003 Hi: I'm glad that SOMEONE ACTUALLY READ MY POST ABOUT CONTRACT LAW and insurance. I am currently conducting an appeal with the help of an attorney who is experienced with health care law. When it is over I will share the good, the bad and the ugly. I don't expect to have it settled before the surgery, but my planning for surgery and recovery has been too complex to delay. Most insurance contracts are filled with contradictions, mis- statements and unclear language. As mentioned by others, the insurance company clerks who initially reject you are merely following reflex orders. The denial letters are designed to discourage you from appealing. Most physician offices are not really equipped to conduct your appeal. You need to do it yourself or get some professional legal help. In any case, my resurfacing will be done on March 31st at Duke by Dr. Vail. I am further encouraged by the recent postings such as the " 3 week letter " . Best of luck to everyone and keep up the helpful postings on surface hippy. in NC. > >> > After 2 1/2 months of waiting, my insurance turned me down for > >> resurf > >> > as it is not FDA approved. I am really mad because, according to > >> my > >> > doc, this same insurance has paid for several resurfs in the past > >> > with no hassle. I feel like I am being discriminated against and > >> > don't look forward to limping around in pain waiting for the FDA > >> to > >> > do their thing as I do not want a shank of steel down my femur > >> with a > >> > regular replacement. Has anyone else had this happen (if you feel > >> OK > >> > to share)? If so, did filing for a " reconsideration " do any good? > >> > Thanks, this is a great group. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 13, 2003 Report Share Posted March 13, 2003 Hi: I'm glad that SOMEONE ACTUALLY READ MY POST ABOUT CONTRACT LAW and insurance. I am currently conducting an appeal with the help of an attorney who is experienced with health care law. When it is over I will share the good, the bad and the ugly. I don't expect to have it settled before the surgery, but my planning for surgery and recovery has been too complex to delay. Most insurance contracts are filled with contradictions, mis- statements and unclear language. As mentioned by others, the insurance company clerks who initially reject you are merely following reflex orders. The denial letters are designed to discourage you from appealing. Most physician offices are not really equipped to conduct your appeal. You need to do it yourself or get some professional legal help. In any case, my resurfacing will be done on March 31st at Duke by Dr. Vail. I am further encouraged by the recent postings such as the " 3 week letter " . Best of luck to everyone and keep up the helpful postings on surface hippy. in NC. > >> > After 2 1/2 months of waiting, my insurance turned me down for > >> resurf > >> > as it is not FDA approved. I am really mad because, according to > >> my > >> > doc, this same insurance has paid for several resurfs in the past > >> > with no hassle. I feel like I am being discriminated against and > >> > don't look forward to limping around in pain waiting for the FDA > >> to > >> > do their thing as I do not want a shank of steel down my femur > >> with a > >> > regular replacement. Has anyone else had this happen (if you feel > >> OK > >> > to share)? If so, did filing for a " reconsideration " do any good? > >> > Thanks, this is a great group. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 13, 2003 Report Share Posted March 13, 2003 Hi: I'm glad that SOMEONE ACTUALLY READ MY POST ABOUT CONTRACT LAW and insurance. I am currently conducting an appeal with the help of an attorney who is experienced with health care law. When it is over I will share the good, the bad and the ugly. I don't expect to have it settled before the surgery, but my planning for surgery and recovery has been too complex to delay. Most insurance contracts are filled with contradictions, mis- statements and unclear language. As mentioned by others, the insurance company clerks who initially reject you are merely following reflex orders. The denial letters are designed to discourage you from appealing. Most physician offices are not really equipped to conduct your appeal. You need to do it yourself or get some professional legal help. In any case, my resurfacing will be done on March 31st at Duke by Dr. Vail. I am further encouraged by the recent postings such as the " 3 week letter " . Best of luck to everyone and keep up the helpful postings on surface hippy. in NC. > >> > After 2 1/2 months of waiting, my insurance turned me down for > >> resurf > >> > as it is not FDA approved. I am really mad because, according to > >> my > >> > doc, this same insurance has paid for several resurfs in the past > >> > with no hassle. I feel like I am being discriminated against and > >> > don't look forward to limping around in pain waiting for the FDA > >> to > >> > do their thing as I do not want a shank of steel down my femur > >> with a > >> > regular replacement. Has anyone else had this happen (if you feel > >> OK > >> > to share)? If so, did filing for a " reconsideration " do any good? > >> > Thanks, this is a great group. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 13, 2003 Report Share Posted March 13, 2003 , I read all your messages and I appreciate them greatly. I'm currently awaiting my first rejection notice, and am now trying to marshall the resources I'll need to fight that fight. Thank you very much... danz davidrad01 wrote: > Hi: > > I'm glad that SOMEONE ACTUALLY READ MY POST ABOUT CONTRACT LAW and > insurance. > > I am currently conducting an appeal with the help of an attorney who > is experienced with health care law. When it is over I will share > the good, the bad and the ugly. I don't expect to have it settled > before the surgery, but my planning for surgery and recovery has > been too complex to delay. > > Most insurance contracts are filled with contradictions, mis- > statements and unclear language. As mentioned by others, the > insurance company clerks who initially reject you are merely > following reflex orders. The denial letters are designed to > discourage you from appealing. > > Most physician offices are not really equipped to conduct your > appeal. You need to do it yourself or get some professional legal > help. > > In any case, my resurfacing will be done on March 31st at Duke by > Dr. Vail. I am further encouraged by the recent postings such as > the " 3 week letter " . > > Best of luck to everyone and keep up the helpful postings on surface > hippy. > > in NC. > > > > > >> > After 2 1/2 months of waiting, my insurance turned me down > for > > >> resurf > > >> > as it is not FDA approved. I am really mad because, according > to > > >> my > > >> > doc, this same insurance has paid for several resurfs in the > past > > >> > with no hassle. I feel like I am being discriminated against > and > > >> > don't look forward to limping around in pain waiting for the > FDA > > >> to > > >> > do their thing as I do not want a shank of steel down my > femur > > >> with a > > >> > regular replacement. Has anyone else had this happen (if you > feel > > >> OK > > >> > to share)? If so, did filing for a " reconsideration " do any > good? > > >> > Thanks, this is a great group. > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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