Well People, it just keeps getting better & better

[Mousebaby]

Now that we know what is wrong with my head and what keeps causing these awful headaches I get, we look it up under our insurance and they don't pay for the surgery I need to fix the problem.

They say it is investigational and they will not pay for investigational procedures. They said the same thing about the botox injections I was going to have. So it seems I am doomed to have these headaches for the rest of my life.

Does anybody want to have a shotgun party? If so I wanna go first!

 

[Beelzebaby666]

Oh honey I'm sorry!!!

I've heard about the Botox injections and have heard good things about them..If you would PM me, I'd like to know what procedure you looked in to and what they found.

My headaches seemed to disaapear after I quit bartending.. but I had them years before I started working bars:shrug:

I'm so happy to not live with a headache every day anymore and have learned to avoid other triggers like strobe lights and stress. I really hope you find something that works.. I know how hard it is to live day to day when your head hurts so bad you can't see straight.

 

[Geek]

Now that we know what is wrong with my head and what keeps causing these awful headaches I get, we look it up under our insurance and they don't pay for the surgery I need to fix the problem.

They say it is investigational and they will not pay for investigational procedures. They said the same thing about the botox injections I was going to have. So it seems I am doomed to have these headaches for the rest of my life.

Does anybody want to have a shotgun party? If so I wanna go first!

Mousebaby, I read that you should not except a denial from an insurance company. Keep bugging the #### out of them.

 

[BuddyLee]

Mousebaby, I read that you should not except a denial from an insurance company. Keep bugging the #### out of them.

...or get different insurance.

 

[Mousebaby]

Mousebaby, I read that you should not except a denial from an insurance company. Keep bugging the #### out of them.

I have a plan, I only have one kidney, I was born that way. It is or was at 63% function 2 yrs. ago. I have not been checked lately. Due to the amount of pain killers I have been taking I am sure it is doing irreparable damage to the kidney.

So here's my plan. I am going to approach them with these facts and have my kidney Dr. in my pocket to back me up. I am going to say, that taking all the pain meds is going to kill what's left of my kidney and I will end up on Dialysis. Which would you rather pay for. The surgery to get rid of the pain in my head, or the Dialysis I will need for the rest of my life? I will then give them my Neurologists phone number so they can then discuss this with him and if they want to talk to my kidney Dr. as well I'm sure he will back me up on this one.

Wish me luck!

 

[onebdzee]

I have a plan, I only have one kidney, I was born that way. It is or was at 63% function 2 yrs. ago. I have not been checked lately. Due to the amount of pain killers I have been taking I am sure it is doing irreparable damage to the kidney.

So here's my plan. I am going to approach them with these facts and have my kidney Dr. in my pocket to back me up. I am going to say, that taking all the pain meds is going to kill what's left of my kidney and I will end up on Dialysis. Which would you rather pay for. The surgery to get rid of the pain in my head, or the Dialysis I will need for the rest of my life? I will then give them my Neurologists phone number so they can then discuss this with him and if they want to talk to my kidney Dr. as well I'm sure he will back me up on this one.

Wish me luck!

Make sure you put it all in writting and send the letter(s) certified mail to the insurance company to the head of the "claims denial" department.....You also might want to include something from your kidney Dr. to start the "back you up" process

You also may want to contact an attorney(put that in your letter, also)....most insurance companies deny you for a procedure because of costs, but if you mention to them that you have contacted an attorney they will reconsider

Good Luck

 

[Mousebaby]

Make sure you put it all in writting and send the letter(s) certified mail to the insurance company to the head of the "claims denial" department.....You also might want to include something from your kidney Dr. to start the "back you up" process

You also may want to contact an attorney(put that in your letter, also)....most insurance companies deny you for a procedure because of costs, but if you mention to them that you have contacted an attorney they will reconsider

Good Luck

Oh good advice, thank you!

 

[belvak]

Good Luck!!

 

[CalvertNewbie]

I have a plan, I only have one kidney, I was born that way. It is or was at 63% function 2 yrs. ago. I have not been checked lately. Due to the amount of pain killers I have been taking I am sure it is doing irreparable damage to the kidney.

So here's my plan. I am going to approach them with these facts and have my kidney Dr. in my pocket to back me up. I am going to say, that taking all the pain meds is going to kill what's left of my kidney and I will end up on Dialysis. Which would you rather pay for. The surgery to get rid of the pain in my head, or the Dialysis I will need for the rest of my life? I will then give them my Neurologists phone number so they can then discuss this with him and if they want to talk to my kidney Dr. as well I'm sure he will back me up on this one.

Wish me luck!

That sounds like a great plan and I'd take onebdzee's advice also. It is a money game with insurance companies so if you can convince them that this surgery will save them money in the long run, they'll be more likely to go that route for you. I used to be a manager at an insurance company (auto, not health) and it's amazing what sort of "pull" a manager can have once you get to that level. They need to know that you'll continue going up their chain of command until you get to the top of the company, that you're not going to stop. They just hope you'll just drop the matter and accept the denial. Be persistent, downright annoying and relentless. It'll get to the point that they'll dread getting your daily calls and will want to stop them. Sad, but true. Of course, keep a log of your phone calls and always follow up with letters or emails.

I really wish you luck. I know how difficult it is to live with constant headaches. I used to suffer from migraines and they never were able to figure out why despite a year of testing, off & on. They can really disable you and can make life hell. I bet you that all this stress isn't helping the situation either.

 

[Mousebaby]

That sounds like a great plan and I'd take onebdzee's advice also. It is a money game with insurance companies so if you can convince them that this surgery will save them money in the long run, they'll be more likely to go that route for you. I used to be a manager at an insurance company (auto, not health) and it's amazing what sort of "pull" a manager can have once you get to that level. They need to know that you'll continue going up their chain of command until you get to the top of the company, that you're not going to stop. They just hope you'll just drop the matter and accept the denial. Be persistent, downright annoying and relentless. It'll get to the point that they'll dread getting your daily calls and will want to stop them. Sad, but true. Of course, keep a log of your phone calls and always follow up with letters or emails.

I really wish you luck. I know how difficult it is to live with constant headaches. I used to suffer from migraines and they never were able to figure out why despite a year of testing, off & on. They can really disable you and can make life hell. I bet you that all this stress isn't helping the situation either.

No actually it's not, I was up all night and did not get any sleep last night. All I could do is think or cry. I am so disgusted with my insurance. We pay all this money for insurance and they won't cover it. The pay for a little blue pill for a man to get "it" up but they won't pay for me to not be in pain.

 

[Chasey_Lane]

So it seems I am doomed to have these headaches for the rest of my life.

Or pay for the procedure yourself. I know you said a few weeks back you didn't want that, but if that's your only option right now, wouldn't it be better than the pain you are going through daily?

 

[Beth_kennedy]

I have a plan, I only have one kidney, I was born that way. It is or was at 63% function 2 yrs. ago. I have not been checked lately. Due to the amount of pain killers I have been taking I am sure it is doing irreparable damage to the kidney.

So here's my plan. I am going to approach them with these facts and have my kidney Dr. in my pocket to back me up. I am going to say, that taking all the pain meds is going to kill what's left of my kidney and I will end up on Dialysis. Which would you rather pay for. The surgery to get rid of the pain in my head, or the Dialysis I will need for the rest of my life? I will then give them my Neurologists phone number so they can then discuss this with him and if they want to talk to my kidney Dr. as well I'm sure he will back me up on this one.

Wish me luck!

Good luck and keep trying! Hope all goes well for you.

 

[CalvertNewbie]

Or pay for the procedure yourself. I know you said a few weeks back you didn't want that, but if that's your only option right now, wouldn't it be better than the pain you are going through daily?

That's an idea but I wonder how costly it would be? It just sucks to pay so much money for insurance, then not be able to use the benefits you pay for. What a crappy situation she's in right now. Either go into debt (possibly) or live with the pain.

We just switched insurance companies (due to a job change) and once we get the policy, I'll be looking it over with a fine tooth comb - especially the exclusions.

 

[Pasofever]

I am sorry..headaches are horrible..I had one yesterday I could not shake..I thought your allergies (rabbit, chinchilla) was doing it? Sure hope you get it straight..good luck..

 

[Mousebaby]

Or pay for the procedure yourself. I know you said a few weeks back you didn't want that, but if that's your only option right now, wouldn't it be better than the pain you are going through daily?

I don't have this kind of money in order to pay for it myself. There is just no way to do it unless the insurance pays. As it is, the part we are going to have to pay if they do pay is going to be astronomical! I am freaking, but we will manage. Hubby has been working his butt off all day with the insurance company trying to get things arranged. It has not been turned down yet so hopefully we are winning. :crossingeverycrossablethingonmybody:

 

[spinner]

What kind of headaches? My daughter has them, she sees a Dr at Jefferson in Philly. They have a great headache clinic.

 

[dn0121]

I don't have this kind of money in order to pay for it myself. There is just no way to do it unless the insurance pays. As it is, the part we are going to have to pay if they do pay is going to be astronomical! I am freaking, but we will manage. Hubby has been working his butt off all day with the insurance company trying to get things arranged. It has not been turned down yet so hopefully we are winning. :crossingeverycrossablethingonmybody:

Why not just get it and don't pay? If it is going to save your kidney and your life you can figure out the details on how to pay it later. So many people get their little issues paid for by us tax payers that you should be able to. I guess it is just wishful thinking, but it sure isn't right.

Will they not do it unless you make a payment plan or something?

 

[Chasey_Lane]

Why not just get it and don't pay?

What a wonderful idea!!

 

[toppick08]

Why not just get it and don't pay? If it is going to save your kidney and your life you can figure out the details on how to pay it later. So many people get their little issues paid for by us tax payers that you should be able to. I guess it is just wishful thinking, but it sure isn't right.

Will they not do it unless you make a payment plan or something?

Surely, something could be worked out.

:shrug:

 

[kwillia]

What a wonderful idea!!

Why didn't we think of that?