Re: Thanks, everybody! Re: WE WON (Actiq)
- From: "OldGoat" <oldgoatmail@xxxxxxxxxxxxxxxxxx>
- Date: Thu, 27 Sep 2007 23:23:17 GMT
Dear Mike,
GO! GO! GO! GO! GO!
Be the squeaky wheel. I don't know if the new doc situation has you set
where everything is good for you or not, but with the history of problems
you have had with your insurance, I'd be picking up the phone to the State
Insurance folks in a New York minute.
Hang in there, man--og
--
Be Sure to Check Out the PAYNE HERTZ blog, for people with chronic pain, by
people with chronic pain.
join in at: http://paynehertz.blogspot.com
"cllmd" <cllmd@xxxxxxxxxxx> wrote in message
news:ZaUKi.1342$yc5.648@xxxxxxxxxxxxxxxxxxxxxxx
"Mike Berkowitz" <mkberk@xxxxxxxxxxxxxxxxxxxxxxxxxxxxxx> wrote in message
news:of0of31ss1ujo2oko4keruca7su0karj1g@xxxxxxxxxx
On Wed, 26 Sep 2007 18:50:15 GMT, "cllmd" <cllmd@xxxxxxxxxxx> wrote:
Thank you, everybody, for your good wishes and for sharing my joy! Kinda
feels like we all win when one of us breaks thru the
medical/insurance/govt
system, doesn't it?
This was the last hope, shy of starting a lawsuit, the CA State Insurance
Commission. They actually farm it out to group of doctors. These docs
are
paid by the STATE, not the insurances or pharmaceutical companies. The
top
neuro on my case wrote an interesting statement at the end. It's about a
page long. I'll type it up and post it when i get a chance....it's
informative.
But my HI bud Wayne brought up a truth. chris and i are not completely
convinced until those boxes show up on my porch, or we get them at the
pharmacy....haven't spoken with the insurance to find out how i'm to go
about getting them. If i hafta get them from the insurance, it's 3 mths
supply. (cool thing about that would be that, if it's the 3 month thing,
then i'll have the sucker supply to get me thru December and the
holidays.)
Although we are thrilled the state has come thru, the history of this
insurance company makes us sure that they will pull some other trick.
I'm
more than willing to get the suckers thru them, and to go with the
generic,
which i've had and there seems to be zero difference.
The heat makes my head pain much, much worse. We usually are in the 90's
thru Sept and upper 80's thru October. This year we've had a cool
stretch
already. That has been a major blessing.
However....i don't trust stuff going too right. Something always comes
along when the cards are coming up in our favor. There's a shoe due to
drop...
But in the meantime, YEA!!!!!
WHEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE!!!!!!!!!!!!!!!!!!
"Hawaiian Wayne" <birdie998@xxxxxxxxxxx> wrote in message
news:1190799631.201894.122180@xxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
On Sep 25, 6:14 pm, Top <t...@xxxxxxxxxx> wrote:
On Tue, 25 Sep 2007 16:55:40 -0700, cllmd wrote:
The suckers aren't at the door yet, but the paperwork came thru in
our
favor.....the arbitration was binding, and they found that the
insurance
must pay for the suckers.
more later......
thank you for putting up with me!
Lavon
GREAT!! I happy for you!
Top
Aloha Lavon!
Man. I can't tell you how nice it is to come back to this site after a
fairly long (for me!) absence because my monitor died on me and I had
to order a new one (It just came today), only to see this VICTORY POST
on the same day!
Obviously this Actiq works so well for you that it gave you the
strength and determination to fight for your right to have it. That's
usually the only motivation I need to 'fight' through the system
that's set up and WIN. I loosely use that phrase "the system" as it's
more like the "games" the insurance companies play thinking we are too
weak to fight and will just "drop it" eventually, and without a
decision. Hey, if I find a medication that really works for me and my
insurance company refuses to pay for it and there is no other
alternative...I've done the same thing. funny thing is, and I don't
know if you found this to be true also, but did you have to "keep on
your doctors back" in order to get him/her to keep up 'the fight'?
Again, if so, it's all part of "The Game".
Doncha t'ink? Or doncha? CONGRATULATIONS! (Is there a small part of
you that is still holding off the "celebrating" until you "see it to
believe it"?)
I have a few topics I'd love to start threads on that I've said I'd
post and even newer ones that have come up recently that I've STILL
NOT posted! I hope by tomorrow I find the energy.
(One of my threads will explain why I have NO energy right now.)
Aloha For Now,
Hawaiian Wayne
I won a small victory about a year ago: The right to get more epidural
steroid injections. The insurance company did throw a wrench into the
works. Your next hurdle will be to overcome the quantity restriction
imposed by your insurance company unless that was also a part of your
appeal.
I really am interested in hearing just how you did this especially
since it looks like you are in CA.
I does feel good though to win doesn't it.
Mike
Howdy, Mike!
Yep, my dose & quantity is part of the adjudication. I know that the
insurance is going to try to pull something. Still don't know if they are
just that badly managed, or if they are intentionally cruel and slow.
Now, the insurance had sent a few form papers with the last rejection.
They stated that the next step was and independent review at the state
level. We filled out those forms and forwarded them to the state. The
state said the forms were old, outdated and constituted an incomplete
file. That's when we got the lawyer involved (felt like a dead end.)
But the lawyers said to ask the insurance to state the absolute status of
my appeals (there were some date problems and incomplete form letters from
them) and to send the same to the Dept of Insurance...stating that the
letter was to serve both request for status and Dept of Insurance request
for Independent Medical Review.
The Dept of Insurance replied with the forms necessary to fill out, and
stated what else they needed....including a copy of my medical file,
letter from my doctor, policy from the insurance and a copy of my
insurance card.
We got a few bumbling letters from the insurance, stating that they'd
already stated that the matter was finished on their end...actually got
three of those!
The Dept of Insurance basically reviewed the info we sent to make sure it
was complete. That's when United Hellscare sent the dept. info that said
they didn't have jurisdiction. That tied the process up by about 3-4
weeks. After we PROVED they were wrong, the state senior insurance
compliance officer CALLED me, twice, to let me know that the confusion had
been cleared up and my case was going on to the physicians, who would
decide the case.
Gotta say, the CA Dept of Insurance was STELLAR in its dealings with me.
I'll never know if it was because of getting the lawyers involved, but i
was impressed....and i used to instruct customer service.
Mike, the dept office info is the following;
CA Dept of Insurance
Consumer Services and Market Conduct Branch
Claims Service Bureau
300 S. Spring St
LA CA 90013
www.insurance.ca.gov
(213) 346-6570
I dealt with a wonderful lady, Barbara Love.
She is the Senior Insurance Compliance Officer. Her email is
LoveB@xxxxxxxxxxxxxxxx
phone (213) 346-6566
I had both phone and snail mail contact with her, and she was thorough,
professional, and delightful. If you have had two denied appeals with
your insurance, they are the next step. Contact Ms. Love and ask for the
paperwork from them needed to begin an Independent Medical Review.
Mike, if you want, you can email me privately. Once i had the ppwk from
the state, it went rather well...rather smoothly, even with the trick the
insurance pulled. It's worth it.
deep peace,
Lavon
.
- References:
- WE WON (Actiq)
- From: cllmd
- Re: WE WON (Actiq)
- From: Top
- Re: WE WON (Actiq)
- From: Hawaiian Wayne
- Thanks, everybody! Re: WE WON (Actiq)
- From: cllmd
- Re: Thanks, everybody! Re: WE WON (Actiq)
- From: Mike Berkowitz
- Re: Thanks, everybody! Re: WE WON (Actiq)
- From: cllmd
- WE WON (Actiq)
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