Hi
I know I haven't been around much lately. Lots of excuses but they are all boring. No one really cares how many hours I sleep each day or how slowly I move when I can move. Plus my voice has gotten very hoarse so Dragon is not doing as good of a job as it was.
Anyway, I am scheduled to have the intrathecal morphine pump put in tomorrow morning at 7 am.
My doctor's office just called and said that I am no longer eligible with my Private insurance company!
We had just paid the May thru October premiums.

Worker's comp denied the surgery & my lawyer wouldn't go to court to do an expedited appeal for me, SO my Private Insurance sent me a letter of approval with a disclaimer that I must be elibible at the time of surgery.

Well, suddenly after approval for this $100,000. ++ procedure I am no longer eligible. I was injured and out of work 5 years and 3 months ago and they said my Cobra ended after 3 years, even though they continued to cover me an additional 3 yrs +.
Now does that make sense? I wasn't on Cobra, that is why my insurance lasted over 5 years and NOT at Cobra rates ($350./month), it was $64/month because I am an employee of the insurance company. So then a supervisor tells me I am on disability and that ends in 5 years...still this is 5 years and 3 months, not 5 years.
Up until I got the OK to cover my surgery I was covered.
Human Resources said in a week they'll send out a cobra package and retro me back to June 1 and I'll be covered. Like I trust them on that.

Also I can't go on my husbands insurance until July 1st IF they will even cover me. They don't have any pre-existing clause, and I won't know anything today.
Still if I go on my husband's insurance, I will need preauthorization for the surgery and there is no time for that.
So I told the doctors office to cancel it. They had checked with Medicare and my cost would be $992. deductible and 80% coverage. And I don't know if they'll cover the $3000. worth of medications I'll need every month, since I don't have medicare Part D for medicines.
I hope you can all follow this mess.
My husband is going to HR to try to get me on his insurance retro to June 1 because I've had services .
I think of Olecyn when I see what a mess I'm in....sorry Cyndy, but I know you pay out of pocket for medical care too. I'm not sure what will happen but I'll keep you updated throught the day, if you'd like to hear this nightmare. It never stops, it is one night mare after another. I understand more and more how people who have RSD and TOS can commit suicide (not that I'd think of it). But it sure would end this nightmare.
Work COmp hasn't paid a thing on me for 5 years this Sept. My lawyer never goes to court for me. I have $100,000's of dollars on liens. Unpaid pharmacies, doctors, outpatient surgicenters, botox injections, MRI's. I can't get ANY care for my TOS even though surgery is put into my doctors list of future medical needs. Thanks for letting me vent. I really needed to do that.
((hugs)) Hope

{{{{{Hope}}}}}
I'm so sorry about this mess.
Insurance companies will look for anything to get out of paying.

You probably paid into the insurance plan for 20+ years and never used it. Now you really need them and they have found a way to wiggle out of their responsibility!

I really do care about how much you are suffering with this horrible disease of rsd and tos. I'll be praying for you today, that a good resolution to this mess can be found so you can proceed with your surgery tomorrow with peace of mind.

Love,
Martha

hope,

i am going to try to call you on my way to the OT this afternoon; i'm on the fly right now and just have a sec to post this.

i agree wholeheartedly (and in every sense of that word) with what martha just said. i hate it that they are pulling this nonsense with you.

if i were you, i would be on the phone with the state insurance commissioner right about now. this is outrageous conduct on behalf of your insurance company from what you are telling us (i'd also like to know, exactly when did your doctor's office find out about this coverage issue? seems awfully last minute in the notice dep't; that may just be me though...).

don't know if you've ever corresponded with arnold about your case. if you haven't, you should! if you have, call vanessa about this latest disgrace: 916.445.2841. write the governator @ office of the governor, state capitol, sacramento, CA 95814.

people, unite! damn the man!

i am so sorry you have to let tomorrow go. that by no means MEANS this is over for you, or that you won't ultimately get the permanent morphine pump, hope. where there's a will, there's a way.

you have suffered for far too long.

no more mrs, nice guy. no more smiling depression.

so say i!

alison

write up {or type } a brief accounting & time line of what has happened to you.
email or mail it to your senator, legislator, or even the Pres or VP!
It worked for Ada {dreambeliever128} http://neurotalk.psychcentral.com/member.php?u=1410}
If you want more info send her a PM asking how she did it.

Oh, Hope...

I am so sorry to hear what they did to you... I know how much you were looking forward to this surgery and getting your life back in order...
You must be devastated... Many Many Gentle to you....

Rant, Yell and Scream the best you can at those insurance people and do whatever is necessary to try and get that pump placed....

You are in my prayers today... God will see you thru this and you will be able to proceed with the surgery soon...

If you can... Take the advice from Martha, Alison and Jo...

You are in my prayers...

To you
Dawn

P.S. Johanna has a Great Point.. If I can help you too.. Just let me know I will call or write for you too... Anything for you my Dear Friend...

Hope, I sincerely from the bottom of my heart, just want you to know how sorry I am about everything. I am praying that you get much needed help. I pray one of these companies will come through and pay for the pump you so desparately need. You my friend are one reason I keep fighting for my rights with wc. They should be responsible for whatever care you need. Keep in touch my friend.

Hope, i have every finger and toe crossed for you. You are such a source of inspiration and positivie vibes to everyone here.

It is criminal the way you are being treated. If I can assist you in writing letters or calling, please let me know how...

Johanna

Hope, I am heart sick!! Hubby and I are shaking our heads in dis-belief!

As if you haven't been through enough already!!

You are always in our prayers and thoughts, and we too, will write, or call the Governor, or what ever we can do to help! Just let us know if there is anything you want or need us to do.

We are so sorry this is happening! Try not to allow this setback to upset you too much so you don't go in to a massive flare. The surgery will get authorized; they can't accept your premiums and then deny it. That's insane! It will probably be rescheduled soon, especially since this was their error.

Hang Tight Sweetheart! I'll call soon and see how you are doing.

Hugs,
Cala

Thanks to all of you and your kind thoughts and words.

The doctor called and when I said to cancel the surgery, she said they want to do it under medicare. I'll owe a ton of money but somehow we'll have to get through it. So I agreed and proceded to make so many phone calls around the insurance company. Once excuse after another.
Then on my third call to member services they said I could go on Cobra retro to June 1st. They'll mail me the stuff on June 6th.
Then they faxed a HIPPA and federal portability form to my husband to prove I have been continually insured all this time. They will insure me with no pre-existing clauses as of July 1.
It may take a year to get my insurance to pay up but I'm ready for the fight.
Cobra is not cheap, but neither is a $100,000. pump

Martha, excellent. I did pay for years and never used it for more than doctor visits and mammograms. I went years without taking sick time and all it got me was TOS and RSD. Thanks for caring and praying. I'm going to need strength post op to fight this battle, but I'll fight it.

Johanna, you hit it on the head with the criminal statement. I have a doctor report who said it is criminal the way work comp is treating me. And another who wrote it is cruel to deny my care. I just may need to use you for lettter writing skills. I hope your recovery continues to go well.
Thanks hairdresser. I know you are fighting the same battle as I am and are stuck too. I am sorry you are worse.

Now, dawn, you know me. Do I look like the type who can yell, rant and scream? I'm doing it all inside but haven't figured how to let those emotions out yet. But it's a great idea. And thanks for the prayers and hugs ... That is what I need now.

Jo, I called my lawyer and he is out of town for two weeks. The person answering phones suggested the same as you. Keep a diary of who I speak to, when, and specifically what it is about, time and dates. I've actually spoken with Ada. She told me what she did but it didn't work for me. She didn't have a worker comp case and she was asking for coverage for a medication. I did try it though. The gov answered me via email and in writing. He handed it over to the dept of Industrial Relations and **** wrote me a letter (ha! Ali) saying "talk to your lawyer." The first line in my letter was that I was writing because talking to my lawyer was not happening.

Alison, that is a good idea too, call the insurance commissioner. First I need to find out if this 5 year rule is in writing somewhere. It was never given or told to me. Then I'll call him and tell him how they did it, no warning at all. My doctor called last month and I was eligible but when they called today to be sure, they found out I was cancelled Thursday and Then Memorial Day weekend. But they usually call day before surgery. Oh have I ever worked with arnold. His emails and letters made it sound like he was going to be there for me and oh how he cares for all us
"caliFOURnians" . He handed my letter over to a **** A. and his letter said, talk to your lawyer. Oh the games they play. I've emailed him again. I even said you'd never let your wife be in this kind of pain for a day, but it has been over 5 years with no relief in sight. He can change this, but all he does is veto the bills to help us. I asked him how dare he be proud of saving Billions of $$ by denying us healthcare and benefits? He's probably got $$ in his hands from the comp lobbyist.

Ya think I ought to change my name to MrToughGuyLivesHere? You are right - I do need to get mean and tough like they are.
Meanwhile I do trust that I'll get through this.

Cala, thanks. I am going to trust it will all be taken care of. It says right after my name on the insurance website that they are returning my money. The bad part is that they never warned me or offered Cobra ahead of time. Thanks for the prayers and thoughts. They really help. The flare set in about 30 minutes ago so I'm going to take my meds and go to bed early - esp since I have to be 45 miles from here by 5:30 am !!

I just thought things were bad enough, but NO, They can Always get Worse.
A good friend told me that a long time ago and I thought she was pessimistic. Now I know she was telling the truth!


Pat

I'm so glad that you are going to be able to proceed with the surgery tomorrow morning. Your in my prayers that your surgery will go as planned and that you will be able to go on those walks that you remember doing so well.
Many Gentle Hugs
Dawn

P.S. I know what you mean about the ranting and yelling.. I'm the same way No Bark and No Bite... But Brewing inside...