Need a little help (1 Viewer)

Dago

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My insurance is denying a needed surgery and their reasons are complete bullshirt

What are my options, if any at this point?
 
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Dago

Dago

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Victim of a hit and run. Had surgery on my thoracic spine and rotator cuff already. Need a procedure done on my lumbar. My doctor is known nationally and is very respected but the insurance is telling him that part of the procedure he is doing uses stem cells which is crap.
 
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Dago

Dago

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Insurance companies are the Devil.

You pay them for decades and when you need them suddenly they don't know you.

Well they did cover the other two, but obviously that doesnt make what is happening now ok

We did appeal the decision and they did a peer review with my doctor. The doctor they chose was a pediatrician. They literally had a pediatrician tell a well known orthopedic surgeon that he was wrong about spine surgery. There has to be some sort of recourse
 

efil4stnias

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Blue cross

I am definitely getting worse between weakness below injury location and pain
Ok

Let me inquire in the am (w my health ins divison) to see what recourse you may have after a peer review. Does your policy happen to mention arbitration or anything?
 
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Dago

Dago

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Ok

Let me inquire in the am (w my health ins divison) to see what recourse you may have after a peer review. Does your policy happen to mention arbitration or anything?

I would need to check. The policy is through my wife's employer. What are the items i need to look at and where would i find it?

Thanks for the help. Things are getting pretty bad...about to need a walker and i am taking five 15mg percs, four 50mg tramadol, and three 50mg lyrica a day. Had an EMG about 7 months ago and at the time there didnt seem to be permanent damage but as i said things have gotten worse

Hate throwing this out here but not sure what else to do
 

efil4stnias

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I would need to check. The policy is through my wife's employer. What are the items i need to look at and where would i find it?

Thanks for the help. Things are getting pretty bad...about to need a walker and i am taking five 15mg percs, four 50mg tramadol, and three 50mg lyrica a day. Had an EMG about 7 months ago and at the time there didnt seem to be permanent damage but as i said things have gotten worse

Hate throwing this out here but not sure what else to do

is this for BCBS LA?
 
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Dago

Dago

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ok i just sent the head of health division email - ill advise soon as i hear.

I truly appreciate this

I was about to put together paperwork to bring to the state insurance commission but don't know if I would get anywhere with that
 

efil4stnias

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I truly appreciate this

well hope i can help. i basically asked her if a peer review is done, is that the end all be all, or does an insured have further recourse?

esp if the "peer" review wasnt exactly "peer" ( pediatrician v ortho )
 

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