surgery denial/ very mad/ venting

December 28, 2002

HI group,

Well, my new insurance company has done what I expected them to do,

the jerks. Instead of going back to North Shore and Dr Bolognese

for my new surgery, they want me to go to a local bone surgeon, his

title starts with an " O " , I can't think of it right now. I'm too

mad.

First they said I had to go there for a second opinion. Sounds

reasonable, right? I asked " If I get a second opinion stating that

I need this surgery, will you then approve my surgery at North

Shore? " IMPORTANT question, because their answer was a flat out

NO!! That would have been a total waste of time and money. I don't

mind a second opinion, but I will NOT have my surgery locally, by a

guy that is not even an NSG, for goodness sake!! They would have

insisted that I have my surgery by this local bone surgeon.

They paid NO ATTENTION AT ALL to Dr Bolognese's letter stating the

need to travel to North Shore for this surgery. All they said of it

was that it was short. HUH???

They also do not understand Chiari AT ALL, and don't think my having

it effects this new surgery in the least. They even screwed up what

surgery I am supposed to be having, calling it a simple discectomy

and laminectomy, completely leaving out the metal plating/fusion

part all together!! No mention in the denial letter of my Chiari

condition.

I am so disgusted. The grievance process will take an estimated 45

days once I get the paperwork back to them. If my grievance is

denied, then I do an appeal, another 45 day estimate. I so love

Priority Health HMO, in Michigan. I got this phone call on

Christmas Eve, and the formal denial letter today. HO HO HO.

What a bunch of egotistical, pigheaded, cheapskate, out of touch

with reality, penny pinching, anal retentive idiots. I wish I could

think up a few more adjectives. GRUMBLE!

Theresa from Michigan

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