That's possibly true, but it stinks nonetheless.

To discriminate against someone just because HE IS NOT DIABETIC, and even to acknowledge the fact that he NEEDS THE OTHOTICS and the CUSTOM SHOES to walk otherwise HE CAN'T WALK, well, to me, it stinks.

I was on the phone with Maximus 7 days ago (before I got the denial). I wanted to know where they stood and if they made the determination. The lady on the other end said "We'll be making this determination next week".

I then carefully and politely explained all about Alan's neuropathy and ulcers and she listened and I said "am I getting through to you at all?" and she said "oh yes, and we often disagree with the original decision and we reverse it?" and I said "you mean, this might just turn out favorably for my husband?" and she said "absolutely".

Well, ABSOLUTELY didn't come did it? They turned him down.

What stinkers.

melody

I got a letter telling me they didn't want to pay for any more IVIG, and if I pushed it, they would deny me retroactively, which would have left me with a bill of 70-90K$. That smacked of something illegal. Kind of extortion like.

They reversed themselves, after I fought it. Can you imagine telling the patient that not only will they not pay for future treatment, but also that they would come after you by denying retroactively, if you tried to fight it!

Insurance companies are dirty.

Anyway, they are now paying for my IVIG and admitted a mistake. Mistake my....They thought I would not contest for fear of being saddled with a huge retroactive denial.

My daugther is sitting with an 8K bill because the procedure she had has no code. She has appealed and is fighting it.

Don't get me started on insurance companies....

A few years ago, i was told that i needed orthotic inserts. I was denied by my insurance company and they told me that they follow medicare rules and that shoes and inserts are only for diabetic peripheral neuropathy. So this rule goes back at least 3 years. In my opinion this rule is a result of all of the clinical trials for anything concerning peripheral neuropathy being done on those with diabetic peripheral neuropathy only. Discrimination at its finest. Its totally assinine. Its the same disease just with a different cause. I wound up having to pay for them myself.

To Cyclelops:

Scariest story, jeeez. I told Alan, don't mention anything about IVIG, he replied "I'm not scared of them" Oh brother.

To: Echoes:

Thank you so much for sharing. It's discrimination at its finest, isn't it?
I wonder if we could get the ACLU involved. Maybe they could accompany us to the hearing?

Mel

im with alan, im not scared of them either. At least you are getting a hearing, most of these people you can never get to answer the phone....voice mail has become a convenient way to ignore you.

this situation is exactly where an advocacy group should step in to try to rectify this whole only for diabetic neuropathy criteria. I remember reading about an advocacy group in california for people with PN but havent heard anything about them in a few years.

Well, I'll be contacting the ACLU (don't know who else could help), will update you all when I know ANYTHING.

until then, crossing fingers toes and everything else. (including my sprouts)

mel

--since they're always looking for ways to get more publicity for the condition and the difficulties in treating it.

www.neuropathy.org (and I think there's a phone number fo the office on the website--and you guys are part of a sponsored support group, correct?).

WHAT A SUPER IDEA!!!

Well contact them today.

You're an angel!!!

Melody

Well, THAT WAS A DEAD END!!!

Just got off the phone with the Neuropathy Association. We are members in good standing, (meaning paid up).

I told him Alan's problem and asked if they had any advocacy person, or can they do anything to help Alan, (for example, have someone come to the hearing), or do ANYTHING to help our cause in dealing with HMO's.

The guy was very nice but explained that "no, we don't do anything of that nature, we once tried to get an advocate but there is no funding and we are not a big enough group to do this" I'm just quoting exactly what he said.

Amazing, no??

Melody