Claim Denied!!!

Originally Posted by mousersdad

have the BF and you keep calling the insurance company and the doctors office, have the doctors office change there papers for the blood clot for the tests and have BF talk to his employer about the insurance,,,I think he was misled????? Have a better day, home soon:

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Welcome to TCS - finally!!!

Keep fighting with the insurance company for denying that claim. My experience has been that they thing you won't bother fighting it. If you complain to high enough management, sometimes they'll even pay a portion of the bill just to make you go away. You can also file a complaint with the Better Business Bureau. It is really easy to do and it often gets companies' attention.
Also, complain to your workplace. If your workplace hears enough complaints from employees, they might go to the insurance company - the insurance company certainly doesn't want to lose your company's business.
Good luck!

Wow. I just got through to the doctor's office. They are going to fax me a form to have my fiancee sign. After I fax it back to them they will "work" on releasing his medical records. They only do this on Wednesday afternoons. They are open on Wednesday morning, but not on Wednesday afternoons. I was told to call on Thursday to see if they are ready.
I explained that I have been calling since Tuesday. She said "well, you were on the list to call back." HUH?
How long does it take to make copies????????? He was only there for the one visit and follow-up the next day.
I am so ticked off!

Originally Posted by ugaimes

Renee, I am just so angered reading this! I'm glad DF's leg is feeling better, but that is just horrible.

You know, Michael Moore is making a movie (wow, alliteration!) about healthcare in America because of this very sort of thing!

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Thanks, Amy. When this is all over, I will be filing complaints. BTW, I helped my ex MIL win a dispute with the same provider about 10 years ago.

I just caught the DF part. I couldn't figure out the abbreviation. Thanks.

I was finally allowed to pick up the medical records, so now I can begin my battle!!! As far as I can tell, there is NOTHING in the records that indicate he was there for any pre-existing condition. It does MENTION that he was accessed to have these conditions, but IMO, thats what every doctor does on your first visit, right...? ask your medical history. Bottom line, though - THE RECORDS MAKE IT VERY CLEAR THAT HE WAS THERE FOR SOMETHING OTHER THAN PRE-EXISTING CONDITIONS. Oops, sorry for yelling. I was getting excited.
His bp the day of the visit was 116/80. It was obviously under control - more proof that he wasn't there for that reason. HA!

My 2 cents.
Neil has been taking 500 mg of Glucosamine Sulfate twice a day for 3-4 yrs.
Way back in High School he had a knee injury. It had been bothering him say like 8 yrs ago but being a guy-wouldn't go to doctor. He had his knee re-scoped and the arthritis cleaned out. He has pictures from the doc on what arthritis looks like!!! Anyhow the ortho doc recommended Glucosamine which he has taking ever since.
As for Gout my dad has suffered with that off and on for decades-normally it affects the toes first and is VERY painful. Does he take anti inflamatories for his hip???? Heating Pad??? Maybe whirlpool/hottub????

Renee,

If you were to put him on your insurance, would there be a pre-existing condition clause?

Originally Posted by AbbysMom

Renee,

If you were to put him on your insurance, would there be a pre-existing condition clause?

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Karen, I don't know, but I couldn't do that until we get married anyways, which will be soon. I did check the price and it will cost me $100.00 a week which isn't really affordable compared to the $28.00 he is paying now. His pre-existing condition exemption will expire on July 11 2006.

The poor guy took this job (at my suggestion/begging) mostly because of the insurance.

$100 more a week is insane!!!!!

Originally Posted by AbbysMom

$100 more a week is insane!!!!!

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Yup. My company pays 75% of my insurance, but employees pay 100% of any dependents.

But alot of US companies are moving in a similar direction. Even though I am on severance from my last job I still get ex-company news and this yr if your spouse can be covered for health insurance from their employer they should switch. If they do not you would be responsible for a $110/monthly surcharge!!

Well, it took awhile. I wrote a letter and my DF signed it. We heard back that they have PAID THE CLAIM IN FULL!!! I am sooooooooo happy that he no longer has a balance due!!!
I don't know why we had to go through all this is the first place, but QUIT B*TCHIN', RENEE!

EXCELLENT NEWS!!!

That's great! By the way, how is he doing on the fish oil? I started taking some in November and it took away a lot of my joint pain. I thought I had experienced a miracle because it took a couple weeks to work and I had forgotten I was taking it!

Thank you both so much!!!

Originally Posted by kluchetta

That's great! By the way, how is he doing on the fish oil? I started taking some in November and it took away a lot of my joint pain. I thought I had experienced a miracle because it took a couple weeks to work and I had forgotten I was taking it!

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He hasn't noticed any improvement yet. The good news is that he hasn't given up. He is taking a glucosamine complex too. I hand him all his vitamins and supplements in the morning with a glass of milk and walk away before he complains. Its working for me so far.

Originally Posted by Rockcat

Thank you both so much!!!

He hasn't noticed any improvement yet.

The good news is that he hasn't given up. He is taking a glucosamine complex too. I hand him all his vitamins and supplements in the morning with a glass of milk and walk away before he complains.

Its working for me so far.

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I used to work with a doctor of alternative medicine. He said different vitamins have different bioavailability. So where one brand is absorbed, another may not be. If he sticks with one brand of glucosamine for 4-6 weeks, and sees no improvement, you might want to try another brand.

Also, different arthritis is from different sources, so the glucosamine only helps with one kind. Personally, I had LOTS of aches and pains in my hips. Also in my hands when the weather was cold. Now, 10 years after taking a course of glucosamine for about 2 months, I have almost no pain. And I don't take the supplements anymore. Of course, he has a more severe case, but the idea is the same. If the glucosamine and other supplements help, the cartilage in his joints will heal and smooth, and the pain will be greatly lessened.

Good for you in getting the insurance to pay. DH's insurance denies everything, and needs the MD office to resubmit claims. That is part of why we switched to insurance through my company instead!

Awesome news on the claim being paid. Lots of work on your behalf but it was worth it!!

Originally Posted by GailC

Awesome news on the claim being paid. Lots of work on your behalf but it was worth it!!

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Waaaaaaaay worth it! Thanks.