Archive for the ‘Insurance Company’ tag
Insurance and rehab question
When my daughter went into rehab her insurance okayed 10 days with us paying $1665. After the ten days she went into their halfway house and we paid for that. Now my daughter has received a bill from the insurance company that said they have reviewed her claim and will not pay $3000 of the charges. She was preapproved and that is the only reason she stayed in the rehab part for the 10 days. She was stable on the Suboxone after 3 days and could have gone into the halfway house at that time. The only reason the hospital waited the 10 days was because her insurance had approved it. Now she does not know what to do. She does not have the money to pay for them and I truly believe it is not fair that, after the fact, and when she does not have a choice that she will be owing $3,000. I told her that we would fight it because I know what they told me at the business office at the rehab. That my $1665 would cover the difference. Has anyone else had this problem and what did they do. Thanks, Marle
Some battles are just not worth fighting.
Some battles are just not worth fighting.
Yours truly hasn't been feeling too good. My condition has continued to deteriorate, which is the normal progression of this disease. Neuro wanted to run some tests to see exactly where I'm at. Nothing fancy, just bloodwork and a EMG, standard tests for neuropathy. The EMG would show if the "small fiber neuropathy" that I have has spread into "large fiber". Neuropathy always spreads, there's no way to stop it.
Diabetics commonly get the large fiber type. It damages the sensory nerves and blood flow in the extremeties. Starting at the toes and moving up the legs. With early detection, rigid diet and plenty anti-inflamatories most diabetics can get by without too much trouble and eventually die of old age. A few unlucky ones will have it spread into the small fiber type late in life.
The type I have is small fiber. That affects the autonomic nerves, usually starting with the control of breathing, blood pressure and heart rate. Most of us don't live long enough to have it spread anywhere else. When it does spread it goes up into the throat and head, as well as down into the stomach and intestines. That's what the tests were for, to see where it's spread.
Doc called the insurance company (Blue Shield PPO), sent my records so they would know every last detail, and got everything approved in writing. Waited a couple months in case they changed their mind, and then we did the tests.
Good news is that I have very little spread into large fiber. Just a teensy bit. Enough to make one of my toes be almost numb, enough to be causing circulation problems in the sole of one foot, but not much else. Not so good news is that it is definetly in my stomach and throat. I'm having trouble digesting, intestines are not absorbing nutrients like they should, and I'm having trouble swallowing. With that information we decided to switch me to a stronger anti-inflamatory called "decadron", because the kenalog I am taking is just not quite doing the job.
Can't raise my kenalog cuz it trashes my immune system. Last thing I need is some silly little infection to spread to my bad valve, or into my heart or lungs where I'm not getting good circulation. That happened a couple years ago and into the ICU I went.
Insurance company calls my doc and says they're not paying. Not paying _anything_ for me, in fact they're dinging her on _all_ statements, even simple office visits. They're demanding research papers demonstrating that EMG is a standard test. (by the way, it's part of the standard protocol of all kinds of medical associations from the AMA to the ADA) They also tossed her out of the plan, she can't take Blue Shield anymore.
We decided not to start on the decadron now because she won't be able to follow me. Decadron is actually a type of chemotherapy used for cancer patients, it just happens to have a side effect that knocks down inflamations like neuropathy. It's not the kind of thing I want to be taking without a neuro watching over me.
So now I'm off to find a new neurologist. That's more time off work, more visits, more co-pays.
I decided not to fight the insurance company on this one. I'm really tired, I feel like **** most days, and I'm still fighting several other battles from years back. If I had the energy, time and money I would fight every last battle, but I'm running out of all of the above. So this time I'm letting them off the hook.
To get my spirits up my g/f LC and I decided to get outta town for a weekend. She's looking up marathons and I'm dusting off my cameras. I decided that if you can't beat 'em ..... go party ;) Oh yeah, speaking of which, we had a great Halloween. I was disguised as a hot dog and she was a bottle of Mustard. We went partying all over town and even walked into the wrong party cuz we had the wrong address!!!!!! Not to worry, they were nice people and we made some new friends.
Met one of the guys that bank-rolled the casinos when they first were built in Vegas. .... wow is he old!!! ....and wow does he have the best stories to tell. .....and wow does he have tons of body-guards all over the place !!!! and we also met one of the top entertainers here in Vegas ..... wow is she young !!!! ..... and wow is she loading up the cash by the barrel.... and wow is her hubby a gentle, kind guy who deserves a better wife !!!!
You know, I am _so_ having a great life. Vegas is such a fun town, and I've got so many wonderful friends. I know this ride won't last forever but it sure is one heck of a good one. Sucks to be sick all the time but everything else just rocks. Especially you recovery-noids who listen patiently to my rants (((((( hugs ))))))
Mike :)
Yours truly hasn't been feeling too good. My condition has continued to deteriorate, which is the normal progression of this disease. Neuro wanted to run some tests to see exactly where I'm at. Nothing fancy, just bloodwork and a EMG, standard tests for neuropathy. The EMG would show if the "small fiber neuropathy" that I have has spread into "large fiber". Neuropathy always spreads, there's no way to stop it.
Diabetics commonly get the large fiber type. It damages the sensory nerves and blood flow in the extremeties. Starting at the toes and moving up the legs. With early detection, rigid diet and plenty anti-inflamatories most diabetics can get by without too much trouble and eventually die of old age. A few unlucky ones will have it spread into the small fiber type late in life.
The type I have is small fiber. That affects the autonomic nerves, usually starting with the control of breathing, blood pressure and heart rate. Most of us don't live long enough to have it spread anywhere else. When it does spread it goes up into the throat and head, as well as down into the stomach and intestines. That's what the tests were for, to see where it's spread.
Doc called the insurance company (Blue Shield PPO), sent my records so they would know every last detail, and got everything approved in writing. Waited a couple months in case they changed their mind, and then we did the tests.
Good news is that I have very little spread into large fiber. Just a teensy bit. Enough to make one of my toes be almost numb, enough to be causing circulation problems in the sole of one foot, but not much else. Not so good news is that it is definetly in my stomach and throat. I'm having trouble digesting, intestines are not absorbing nutrients like they should, and I'm having trouble swallowing. With that information we decided to switch me to a stronger anti-inflamatory called "decadron", because the kenalog I am taking is just not quite doing the job.
Can't raise my kenalog cuz it trashes my immune system. Last thing I need is some silly little infection to spread to my bad valve, or into my heart or lungs where I'm not getting good circulation. That happened a couple years ago and into the ICU I went.
Insurance company calls my doc and says they're not paying. Not paying _anything_ for me, in fact they're dinging her on _all_ statements, even simple office visits. They're demanding research papers demonstrating that EMG is a standard test. (by the way, it's part of the standard protocol of all kinds of medical associations from the AMA to the ADA) They also tossed her out of the plan, she can't take Blue Shield anymore.
We decided not to start on the decadron now because she won't be able to follow me. Decadron is actually a type of chemotherapy used for cancer patients, it just happens to have a side effect that knocks down inflamations like neuropathy. It's not the kind of thing I want to be taking without a neuro watching over me.
So now I'm off to find a new neurologist. That's more time off work, more visits, more co-pays.
I decided not to fight the insurance company on this one. I'm really tired, I feel like **** most days, and I'm still fighting several other battles from years back. If I had the energy, time and money I would fight every last battle, but I'm running out of all of the above. So this time I'm letting them off the hook.
To get my spirits up my g/f LC and I decided to get outta town for a weekend. She's looking up marathons and I'm dusting off my cameras. I decided that if you can't beat 'em ..... go party ;) Oh yeah, speaking of which, we had a great Halloween. I was disguised as a hot dog and she was a bottle of Mustard. We went partying all over town and even walked into the wrong party cuz we had the wrong address!!!!!! Not to worry, they were nice people and we made some new friends.
Met one of the guys that bank-rolled the casinos when they first were built in Vegas. .... wow is he old!!! ....and wow does he have the best stories to tell. .....and wow does he have tons of body-guards all over the place !!!! and we also met one of the top entertainers here in Vegas ..... wow is she young !!!! ..... and wow is she loading up the cash by the barrel.... and wow is her hubby a gentle, kind guy who deserves a better wife !!!!
You know, I am _so_ having a great life. Vegas is such a fun town, and I've got so many wonderful friends. I know this ride won't last forever but it sure is one heck of a good one. Sucks to be sick all the time but everything else just rocks. Especially you recovery-noids who listen patiently to my rants (((((( hugs ))))))
Mike :)
The Stella Awards
It's time again for the annual 'Stella Awards'! For those unfamiliar with these awards, they are named after 81-year-old Stella Liebeck who spilled hot coffee on herself and successfully sued the McDonald's in New Mexico where she purchased the coffee. You remember, she took the lid off the coffee and put it between her knees while she was driving. Who would ever think one could get burned doing that, right?
That's right; these are awards for the most outlandish lawsuits and verdicts in the U.S . You know, the kinds of cases that make you s cratch your head. So keep your head scratcher handy.
Here are the Stella's for the past year:
7TH PLACE :
Kathleen Robertson of Austin , Texas was awarded $80,000 by a jury of her peers after breaking her ankle tripping over a toddler who was running inside a furniture store. The store owners were understandably surprised by the verdict, considering the running toddler was her own son.
6TH PLACE:
Carl Truman, 19, of Los Angeles, California won $74,000 plus medical expenses when his neighbor ran over his hand with a Honda Accord. Truman apparently didn't notice there was some one at the wheel of the car when he was trying to steal his neighbor's hubcaps.
Go ahead, grab your head scratcher.
5TH PLACE:
Terrence Dickson, of Bristol, Pennsylvania, who was leaving a house he had just burglarized by way of the garage. Unfortunately for Dickson, the automatic garage door opener malfunctioned and he could not get the garage door to open. Worse, he couldn't re-enter the house because the door connecting the garage to the house locked when Dickson pulled it shut. Forced to sit for eight, count 'em, EIGHT, days on a case of Pepsi and a large bag of dry dog food, he sued the homeowner's insurance company claiming undue mental Anguish.
Amazingly, the jury said the insurance company must pay Dickson $500,000 for his ang uish. We should all have this kind of anguish.
Keep scratching. There are more...
4TH PLACE :
Jerry Williams, of Little Rock , Arkansas , garnered 4th Place in the Stella's when he was awarded $14,500 plus medical expenses after being bitten on the butt by his next door neighbor's beagle - even though the beagle was on a chain in its owner's fenced yard. Williams did not get as much as he asked for because the jury believed the beagle might have been provoked at the time of the butt bite because Williams had climbed over the fence into the yard and repeatedly shot the dog with a pellet gun.
Grrrrr. Scratch, scratch.
3RD PLACE:
Amber Carson of Lancaster, Pennsylvania because a jury ordered a Philadelphia restaurant to pay her $113,500 after she slipped on a spilled soft drink and broke her tailbone. The reason the soft drink was on the floor: Ms. Carson had thrown it at her boyfriend 30 seconds earlier during an argument. What ever happened to people being responsible for their own actions?
Scratch, scratch, scratch. Hang in there; there are
only two more Stellas to go...
2ND PLACE:
Kara Walton, of Claymont, Delaware sued the owner of a night club in a nearby city because she fell from the bathroom window to the floor, knocking out her two front teeth. Even though Ms. Walton was trying to sneak through the ladies room window to avoid paying the $3.50 cover charge, the jury said the night club had to pay her $12,000....oh, yeah, plus dental expenses. Go figure.
1ST PLACE : (May I have a fanfare played on 50 kazoos please)
This year's runaway First Place Stella Award winner was Mrs. Merv Grazinski, of Oklahoma City , Oklahoma , who purchased a new 32-foot Winnebago motor home. On her first trip home, from an OU football game, having driven on to the freeway, she set the cruise control at 70 mph and calmly left the driver's seat to go to the back of the Winnebago to make herself a sandwich.
Not surprisingly, the motor home left the freeway, crashed and overturned. Also not surprisingly, Mrs. Grazinski sued Winnebago for not putting in the owner's manual that she couldn't actually leave the driver's seat while the cruise control was set. The Oklahoma jury awarded her, are you sitting down, $1,750,000 PLUS a new motor home. Winnebago actually changed their manuals as a result of this suit, just in case Mrs. Grazinski has any relatives who might also buy a motor home.
Are we, as a society, getting more stupid...? Ya Think??!!
More than a few of our judge's elevators don't go to the top floor either!
WHAT'S EVEN SCARIER - THESE JURORS AND JUDGES MAY VOTE ON ELECTION DAY!!!
That's right; these are awards for the most outlandish lawsuits and verdicts in the U.S . You know, the kinds of cases that make you s cratch your head. So keep your head scratcher handy.
Here are the Stella's for the past year:
7TH PLACE :
Kathleen Robertson of Austin , Texas was awarded $80,000 by a jury of her peers after breaking her ankle tripping over a toddler who was running inside a furniture store. The store owners were understandably surprised by the verdict, considering the running toddler was her own son.
6TH PLACE:
Carl Truman, 19, of Los Angeles, California won $74,000 plus medical expenses when his neighbor ran over his hand with a Honda Accord. Truman apparently didn't notice there was some one at the wheel of the car when he was trying to steal his neighbor's hubcaps.
Go ahead, grab your head scratcher.
5TH PLACE:
Terrence Dickson, of Bristol, Pennsylvania, who was leaving a house he had just burglarized by way of the garage. Unfortunately for Dickson, the automatic garage door opener malfunctioned and he could not get the garage door to open. Worse, he couldn't re-enter the house because the door connecting the garage to the house locked when Dickson pulled it shut. Forced to sit for eight, count 'em, EIGHT, days on a case of Pepsi and a large bag of dry dog food, he sued the homeowner's insurance company claiming undue mental Anguish.
Amazingly, the jury said the insurance company must pay Dickson $500,000 for his ang uish. We should all have this kind of anguish.
Keep scratching. There are more...
4TH PLACE :
Jerry Williams, of Little Rock , Arkansas , garnered 4th Place in the Stella's when he was awarded $14,500 plus medical expenses after being bitten on the butt by his next door neighbor's beagle - even though the beagle was on a chain in its owner's fenced yard. Williams did not get as much as he asked for because the jury believed the beagle might have been provoked at the time of the butt bite because Williams had climbed over the fence into the yard and repeatedly shot the dog with a pellet gun.
Grrrrr. Scratch, scratch.
3RD PLACE:
Amber Carson of Lancaster, Pennsylvania because a jury ordered a Philadelphia restaurant to pay her $113,500 after she slipped on a spilled soft drink and broke her tailbone. The reason the soft drink was on the floor: Ms. Carson had thrown it at her boyfriend 30 seconds earlier during an argument. What ever happened to people being responsible for their own actions?
Scratch, scratch, scratch. Hang in there; there are
only two more Stellas to go...
2ND PLACE:
Kara Walton, of Claymont, Delaware sued the owner of a night club in a nearby city because she fell from the bathroom window to the floor, knocking out her two front teeth. Even though Ms. Walton was trying to sneak through the ladies room window to avoid paying the $3.50 cover charge, the jury said the night club had to pay her $12,000....oh, yeah, plus dental expenses. Go figure.
1ST PLACE : (May I have a fanfare played on 50 kazoos please)
This year's runaway First Place Stella Award winner was Mrs. Merv Grazinski, of Oklahoma City , Oklahoma , who purchased a new 32-foot Winnebago motor home. On her first trip home, from an OU football game, having driven on to the freeway, she set the cruise control at 70 mph and calmly left the driver's seat to go to the back of the Winnebago to make herself a sandwich.
Not surprisingly, the motor home left the freeway, crashed and overturned. Also not surprisingly, Mrs. Grazinski sued Winnebago for not putting in the owner's manual that she couldn't actually leave the driver's seat while the cruise control was set. The Oklahoma jury awarded her, are you sitting down, $1,750,000 PLUS a new motor home. Winnebago actually changed their manuals as a result of this suit, just in case Mrs. Grazinski has any relatives who might also buy a motor home.
Are we, as a society, getting more stupid...? Ya Think??!!
More than a few of our judge's elevators don't go to the top floor either!
WHAT'S EVEN SCARIER - THESE JURORS AND JUDGES MAY VOTE ON ELECTION DAY!!!
I need your help please
I've not been here for a long, long time. I've just simply gone downhill.
I'm unemployed now so I can totally devote my days and my nights to drinking my life away.
I have really, really good insurance........Anthem........the best plan they offer.
My question is this.............where do I begin?
Do I start with a doc and ask for the pills that help you not to drink, do I start with AA or do I start with the insurance company?
I'm ready to check in to rehab.......ready to do whatever it takes.
I'm to the point that I drink all day and all night...........crash for a day to get over the hangover and then go do it again.
My life is totally out of control and I need help and I need help bad and I need it now.
I am a drunk.............an alcholic...............I can't help myself no more.......I need someone to help me help me and I want it.
Where do I begin? Please help me!
Love.............Starlite Dawn
PS...........Thank you in advance..............
I'm unemployed now so I can totally devote my days and my nights to drinking my life away.
I have really, really good insurance........Anthem........the best plan they offer.
My question is this.............where do I begin?
Do I start with a doc and ask for the pills that help you not to drink, do I start with AA or do I start with the insurance company?
I'm ready to check in to rehab.......ready to do whatever it takes.
I'm to the point that I drink all day and all night...........crash for a day to get over the hangover and then go do it again.
My life is totally out of control and I need help and I need help bad and I need it now.
I am a drunk.............an alcholic...............I can't help myself no more.......I need someone to help me help me and I want it.
Where do I begin? Please help me!
Love.............Starlite Dawn
PS...........Thank you in advance..............
Anxiety, anxiety, anxiety!
Im having really bad anxiety today.
Ive been trying to contact the guys car I hit on friday. I called the guy all weekend, and now Im tryin to call his insurance company too with no return calls. I just want to get this guys car in the shop and get it paid for. He's holding out to see if Pauls insurance will pay for this. It wont as Im not covered. We are wanting to pay cash.
This is a really stressful situation. I havea doctor appointment tomarrow and am grateful. I still dont feel rght. My kidneys hurt constantly no matter what. There is alot of things that are just up in the air right now and I dont know how to fix it.
Ive been trying to contact the guys car I hit on friday. I called the guy all weekend, and now Im tryin to call his insurance company too with no return calls. I just want to get this guys car in the shop and get it paid for. He's holding out to see if Pauls insurance will pay for this. It wont as Im not covered. We are wanting to pay cash.
This is a really stressful situation. I havea doctor appointment tomarrow and am grateful. I still dont feel rght. My kidneys hurt constantly no matter what. There is alot of things that are just up in the air right now and I dont know how to fix it.
Trying to Stay Stong
Well tomorrow will be one week since I broke up with ABF. So far, yesterday was the worst day. He got home from the cabin and started calling me over and over and over again. I finally broke down and answered. But, I think I handled things well. It was quite a long conversation with alot of quacking as you can imagine, but I didnt' give in.
A few big things though. First, he kept asking me if he got into treatment if I would take him back. I kept telling him NO. That if he got into treatment 'only' to get me back, it would never work. He finally said 'I'm going to treatment regardless if you take me back or not', I said 'Good, I hope it works out for you, Good luck.". Then, he tells me he needs me to help him. Last week, I cancelled his truck insurance and his cell phone that were in my name. He says, how do I get insurance now? How do I get a cell phone now? How do I go about getting treatment? Really?? I said, you are 41 years old, if you can't call an insurance company, walk in a cell phone store to get a new phone, and walk into an AA meeting all by yourself, then you have more problems than I thought. (Ok, I know that was a mean thing to say, but c'mon!).
Here's the kicker. He then says, 'If you loved me, you would help me. If you still love me, I expect you to want to help me'. I told him that HE does not get to EXPECT anything from me! After all he has put me through, he's lucky I even answered the phone. I told him that this time, he does not get to manipulate me, he does not get to make me feel guilty - because I DON'T. HE has put himself in this position, not ME. I said, if you want to play those games - how about this? If YOU loved ME, you would not have cheated on me, or lied to me, or called me horrible vile names, or yelled at me, or ignored me, or disappeared on me time and time again. He said, 'I'm sorry I called you those names, I didn't mean any of it, it was a vodka day.' Again, really??? I said, I don't care if it was a vodka day, a beer day, a normal day - the point is you said/did those things to me - period.
By this time, I was getting out of control angry. So, I took a deep breath, pulled myself together. Realized that my words mean nothing to an alcoholic - he was just doing everything in his power to manipulate me and 'get his nice comfy enabler' back (as GiveLove told me). So, I told him that I was not going to do this anymore. I told him that I would say another prayer that he got help for himself, but that everything was up to him now - I am out of the picture. I said, I wish you all the luck in the world, but it is out of my hands and I am hanging up now so I can have some peace. Goodbye.
I haven't heard from him since. I know I shouldn't have even answered the phone, and I know I should have 'detached' and not gotten sucked into the conversation and said the things that I did. But, I feel better. I feel better that I told him all those things and I feel better that I stood my ground and did not 'cave' like I usually do. Even though I haven't blocked his number (yet), I'm hoping this is another step in the right direction.
Thank you for letting me share...
Wishing a peaceful day to all!
C
A few big things though. First, he kept asking me if he got into treatment if I would take him back. I kept telling him NO. That if he got into treatment 'only' to get me back, it would never work. He finally said 'I'm going to treatment regardless if you take me back or not', I said 'Good, I hope it works out for you, Good luck.". Then, he tells me he needs me to help him. Last week, I cancelled his truck insurance and his cell phone that were in my name. He says, how do I get insurance now? How do I get a cell phone now? How do I go about getting treatment? Really?? I said, you are 41 years old, if you can't call an insurance company, walk in a cell phone store to get a new phone, and walk into an AA meeting all by yourself, then you have more problems than I thought. (Ok, I know that was a mean thing to say, but c'mon!).
Here's the kicker. He then says, 'If you loved me, you would help me. If you still love me, I expect you to want to help me'. I told him that HE does not get to EXPECT anything from me! After all he has put me through, he's lucky I even answered the phone. I told him that this time, he does not get to manipulate me, he does not get to make me feel guilty - because I DON'T. HE has put himself in this position, not ME. I said, if you want to play those games - how about this? If YOU loved ME, you would not have cheated on me, or lied to me, or called me horrible vile names, or yelled at me, or ignored me, or disappeared on me time and time again. He said, 'I'm sorry I called you those names, I didn't mean any of it, it was a vodka day.' Again, really??? I said, I don't care if it was a vodka day, a beer day, a normal day - the point is you said/did those things to me - period.
By this time, I was getting out of control angry. So, I took a deep breath, pulled myself together. Realized that my words mean nothing to an alcoholic - he was just doing everything in his power to manipulate me and 'get his nice comfy enabler' back (as GiveLove told me). So, I told him that I was not going to do this anymore. I told him that I would say another prayer that he got help for himself, but that everything was up to him now - I am out of the picture. I said, I wish you all the luck in the world, but it is out of my hands and I am hanging up now so I can have some peace. Goodbye.
I haven't heard from him since. I know I shouldn't have even answered the phone, and I know I should have 'detached' and not gotten sucked into the conversation and said the things that I did. But, I feel better. I feel better that I told him all those things and I feel better that I stood my ground and did not 'cave' like I usually do. Even though I haven't blocked his number (yet), I'm hoping this is another step in the right direction.
Thank you for letting me share...
Wishing a peaceful day to all!
C
Another great AA debate - Personal Honesty
What's your opinion on honesty?
Do you think each of us has a different level of honesty?
Or should/do we all adheed to one type to stay sober?
Do you park in paid parking and don't pay? Even if it is just for 5 mins?
Do you pay taxes on ALL those cash jobs?
Would you lie to an insurance company?
I had a sponsor once who said, "We all have different levels of honesty and we have to find the one we feel comfortable living with."
Then on the other hand I've heard an AA old timer say, 'You can do anything you want to in AA, as long as you don't drink and are willing to take responsibilty for your actions."
What do YOU think?
And there is no 'right or wrong' just your ESH (Expereince, Strength and Hope).
Do you think each of us has a different level of honesty?
Or should/do we all adheed to one type to stay sober?
Do you park in paid parking and don't pay? Even if it is just for 5 mins?
Do you pay taxes on ALL those cash jobs?
Would you lie to an insurance company?
I had a sponsor once who said, "We all have different levels of honesty and we have to find the one we feel comfortable living with."
Then on the other hand I've heard an AA old timer say, 'You can do anything you want to in AA, as long as you don't drink and are willing to take responsibilty for your actions."
What do YOU think?
And there is no 'right or wrong' just your ESH (Expereince, Strength and Hope).
