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General control line discussion => Open Forum => Topic started by: Mike Griffin on April 12, 2013, 10:38:13 AM
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I hope Robert will grant me a few lines here to say thank you that does not have anything to do with model airplanes, but then again, it does.
Many of you have offered your well wishes and prayers on here or by personal message on my upcoming surgery which was scheduled for next Wednesday. This past Tuesday I received a phone call from my Neurosurgeon's office telling me that they would have to cancel the surgery because my insurance company would not approve the procedure. The Surgeon has appealed their decision and is communicating with the insurance companies medical director trying to get this approved. Since I turned 65, I now have Humana Medicare (managed care) who uses a third party to determine if I "Qualify" for the surgery. In this case the company that they used to make this determination is called OrthoNet. I have talked to both Humana and OrthoNet and have gotten NO answer as to why I was denied. It is strange to me that before I turned 65 I had no problem having a previous spinal fusion and a total knee replacement. At this point I have not been able to find out why I was denied and if this appeal will be approved. I cannot help but suspect this has something to do with the implementation of Obama Care and if this is going to be the fate for all of us in the last quarter of our lives, we will all be in dire straits.
But I digress. My main point here was to thank you all for your concerns, well wishes and prayers. They mean a lot.
I will continue to push through every day and will be here visiting with you as long as I can stay vertical and in a sitting position. This forum has been a bright spot not only in my hobby but in getting to know some really fine people whom I may never get the chance to shake hands with. This has got to be the next best thing.
Kindest Regards
Mike
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It's probably because when you turn 65 you go on medicare and your 'regular' insurance plan turns to a 'supplemental' plan. This kind of stuff has been going on with my older relatives since before anyone outside of Illinois or Hawaii heard about Barak Obama.
Look for a different plan. Or see if there's any kind of advocate out there to help you get what you want (beyond your neurosurgeon -- it sounds like he's on your side, or at least on the side of getting paid to do this procedure).
Unfortunately the ideal world for any health insurer is to take your money and give you nothing in return; the ideal world for any insured is to pay nothing and be taken care of from cradle to grave. That naturally creates a bit of tension.
You have my best wishes to getting this all sorted out: the last thing you need when you're sick is to be in an argument with your insurer about getting un-sick.
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I just want to say personally, how much I enjoyed your posts. You threw down some kick&^* building threads, which I enjoyed immensely. I sincerely hope we don't see the last of you because you make great contributions, and really contribute to the knowledge base of this forum. Get well soon. H^^
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Mike..
WOW! I AM VIRTUALLY "SPEACHLESS IN GIG HARBAAA" about the news about being turned down for your surgery?
As you know...I had my back surgery over 7 weeks ago...and sloooooooooooooooowly recovering. GADS! WISH THOSE INSURANCE EX'S COULD GO THROUGH A LITTLE PAIN like we have been going through....I KNOW FOR CERTAIN they would have changed their approval in a heartbeat.
Yes!
I am on my wife's PPO and hospital Medicare Hospital (part A) and with that....still have some pretty lofty $$$$ medical expenses to pay that would be enough to buy me a pretty nice little used sports car. SH^
gettin old is NOT FOR WUZZZZZEEEEEEE'S' HB~>
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Mike
I also enjoy your posting and understand your pain, with the back and the insurance company. I injured my back in '98' at work and L&I covered it and told me to re-open the case if I have problems later. Of course, about a year ago it really started acting up. I've always had trouble with it, but the last year has been murder. And L&I has turned down my re-opening twice now. So, I'm going to the neurosurgeon out of my own pocket Tuesday. A small part of me hope's she will say get a lawyer, but that's not my style. So, I hope you get them to change their mind soon. I know what you are going through and we with you brother.
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Mike,
I hope you get things worked out. Obama care has nothing to do with your supplementary healthcare plan approving the procedure. It does require that they cannot deny insurance because of pre-existing conditions. However, Humana's main purpose is to make money rather than take care of their clients. Every procedure they deny is more money for them. Several of my friends have experienced these problems from Humana in recent years. Keep on them!! Those who fight them have a better chance of getting the decision reversed.
Jerry
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Mike,
I hope you get things worked out. Obama care has nothing to do with your supplementary healthcare plan approving the procedure. It does require that they cannot deny insurance because of pre-existing conditions. However, Humana's main purpose is to make money rather than take care of their clients. Every procedure they deny is more money for them. Several of my friends have experienced these problems from Humana in recent years. Keep on them!! Those who fight them have a better chance of getting the decision reversed.
Jerry
"PHILLLLLIPS LAW...JUSTICE FOR U" "MONEY FOR "ONE EYE'D MR.PHILIPS! (On those TV adds that ambulance chasing Lawyer's eyes are so close together it appears almost like his has only ONE BIG EYEBALL right in the middel of his head.:) R%%%%
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Thank you all guys. I will keep fighting this. There is still a chance that my Neuro Doc can get this through but even if he can't I am still going to push what I can to get this approved. At this point I have no idea why I was turned down and that is one question I deserve an answer on. It may not have a thing to do with the new health care laws but something just does not seem right about this whole thing.
Anyway, I am not going anywhere as long as I can type and sit upright..I will just keep building and hoping that someday I can fly them...
Thanks again for all the positive and encouraging words.
Mike
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Mike,
The health care law has nothing to do with them denying your procedure. The law is on-line and you can read it. It is your insurance company. It is the law that they have to tell you why they have denied your coverage. If they do not, your state should have an agency that oversees insurance in the state. If Humana doesn't come through, you can file a formal complaint and cause them some grief. I would suggest you follow Humana's procedure for a formal appeal, which is usually printed on the back of insurance statements. I have been through this junk more than once, and I won every time. Usually your doctor working independent of you can get things done as well. The insurance companies make it a difficult and hope you will give up and they save the money and put it in their pockets. The words "sleeze" and "greed" come to mind.
By the way, the Jaguar kit arrived yesterday, and it is beautiful! Thanks much for the fast and good service!
Good luck,
Jerry
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The insurance companies make it a difficult and hope you will give up and they save the money and put it in their pockets. The words "sleeze" and "greed" come to mind.
See The Incredibles, the scene at Insuri-Care.
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Humana and Aetna score consistently at the bottom of the list in customer satisfaction. While I was working we had Aetna for about a year. They fought you over a routine office visit. Thankfully we ditched them because of their bad service after one year.
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Mike,
We will be with you all the way. This is the kind of stuff that makes people hate insurance companies. Hang in there buddy. Never surrender, never give-up!
Pat
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Yeah Mike, too bad but you have to take the time to fight them (and I think you'll win) ...in the meantime, I
will add your name to my church's prayer chain.
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See The Incredibles, the scene at Insuri-Care.
That was good... LL~ LL~ LL~
Sorry to hear that Mike.
Sue 'em!!!
Marcus
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Tell me this new health care has nothing to do with us. I guess I would have to agree as since I retired and then turned 65 a lot of things are not covered anymore. That is why I now tell those getting ready for retirement to have a complete medical checkup before 65. The new health plan now says I have to pay my wifes medical coverage.
Anyway Mike I hope you get things worked out.
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What a great feeling to have you all supporting me. I will not give up...I will fight till there is no other alternative...
Mike