mamasbabygirl Posted March 24, 2006 Share Posted March 24, 2006 Hello, as I begin my internet search, I will start with my LC family first. TIME TO BANG THE MONKEY!!! I just got off of the phone with the neurosurgeon's right hand woman who has spent the better part of her week talking to the case manager at the insurance company. She has basically run into the general opinion that mom is not strong enough to do more therapy and that the insurance will cover only through next week and then bc of her poor prognosis, she will be on her own. The nurse has used every angle she knows how stating the following: -Mom's systemic disease, both lung and brain are at a better place than they have been in a long time. -Mom wants more therapy -Mom is only 51 -Mom is not expecting a miracle, but we need her to gain some upper body strength to help her with transfers (for example going from a 2+ peson assist to a 1 person assist or maybe independently) I have nearly had it. I need your help with trying to get together some verbiage to call the insurance case manager myself. Right now, I am very emotional that they have given up and am afraid I may lose it. John suggests that I mention that my next call will be to the state insurance regulators, but I am not exactly sure what they do. I called a number for that in KY, but they are of course closed until Monday. Who do I call to make sure that mom's insurance company is treating her fairly? Any other ideas on how to position mom's case? Quote Link to comment Share on other sites More sharing options...
dadstimeon Posted March 24, 2006 Share Posted March 24, 2006 Lori--Very sorry to hear this. Here are some links I hope will be of help or point you in the right direction. Hope this helps. Prayers for the best. Rich http://www.lungcanceronline.org/support/financial.html http://www.plwc.org/plwc/MainConstructo ... 008,00.asp http://www.cancer.com/linksforCategory.jsp?Category=26 http://www.cancercare.org/services.html#counsel Quote Link to comment Share on other sites More sharing options...
Maryanne Posted March 24, 2006 Share Posted March 24, 2006 Hi Lori, I am sorry I have no answers for you. But I do know that you have to try everything you can to try and get this straightened out. Even if the out come is the same at least you will know that you tried. Maybe someone on here went through the same and may have an answer for you. Meanwhile, hang in there. Maryanne Quote Link to comment Share on other sites More sharing options...
karen335 Posted March 24, 2006 Share Posted March 24, 2006 Gosh, Where is Elaine when we need her.... Quote Link to comment Share on other sites More sharing options...
mamasbabygirl Posted March 24, 2006 Author Share Posted March 24, 2006 Wow, Rich, those links actually helped me bunch. The PAF website even has specifics about how to handle each phase of the appeal process. Thanks guys.. Who's Elaine? Quote Link to comment Share on other sites More sharing options...
dchurchi Posted March 24, 2006 Share Posted March 24, 2006 Lori, sorry I do not have any answers or even suggestions, but as always you have my prayers. Quote Link to comment Share on other sites More sharing options...
cindy0519 Posted March 25, 2006 Share Posted March 25, 2006 Lori, Just another small piece of advice for you, based on my experience with Dad's insurance company just last week... Is there a doctor in her medical team that will "carry the sword" with the insurance company for her? If so they could be your best advocate with the insurance company. Contact them and I bet they can get the insurance company to give them approval. Dad's insurance did not want to cover a CT at the hospital his new team is at and the pulmonary doctor said "no way! They are not gonna try to chase peanuts while we are trying to tackel an elephant." Within 20 or 30 minutes his office had obtained the approval. They had to agree with some "conditions" (how the CT would be done - they want with contrast the Dr did not) but they managed to get it approved. Good luck to you and don't give up and don't take no for an answer. If one person tells you no -- go to another, you never call tell what might happen and the worst they can do is deny it. Praying for success for you/Mom! Cindy Quote Link to comment Share on other sites More sharing options...
karen335 Posted March 25, 2006 Share Posted March 25, 2006 What gets me is, the people or group denying treatments are not even doctors... Quote Link to comment Share on other sites More sharing options...
RandyW Posted March 25, 2006 Share Posted March 25, 2006 trying To find Links for you for assistance. This one covers A lot of things for many organizations and states. http://www.canceradvocacy.org/resources ... px?tID=585 http://www.kaiserpapers.org/advocate.html I hope that these in additioon to what rich Found may help you out. Many Prayers. Quote Link to comment Share on other sites More sharing options...
Don M Posted March 25, 2006 Share Posted March 25, 2006 Lori probably appealing with the support of a doctor is best for now, but I wold also call the state insurance regulators to see what they say. So far it appears that the insurance company has not recieved a signed letter from a doc, right? You might have to take it up a notch. At the time of my last surgery I was offered assistance my my insurance company's case manager. The idea was that she was supposed to review all my porposed treatments and look out for my interests so that I would not have to and just focus on getting better. I declined. I guess I was being a little paranoid, but who knows? I did not want her to turn into a stumbling block. Don M Quote Link to comment Share on other sites More sharing options...
Linda661 Posted March 25, 2006 Share Posted March 25, 2006 Loved that PAF website too (even added that one to my favs. for future reference!). I support what Don said. But if you find your initial appeals process frustrating, an inquiry to your state insurance commissioner can help put some "teeth" into your appeal. There should be a consumer protection division to the insurance commissioner's office in your state: "The Consumer Protection Division will investigate the complaint of any insurance consumer who feels he or she was treated unfairly by a carrier. We can help if you are having a problem with an insurance agent, broker, company or adjuster. Different parts of our office deal with different sorts of problems." (this is a quote from my state's office -- did a quickie look-see, yours must have the same sort of thing). It's like putting other people to work on your behalf, and people from an office which regulates insurance practices at that! Do try to do what you can first, though....I am sure that there is a bureaucratic tangle to that one and you will probably command more of their attention when they know you have tried on your own first, "in good faith" with your mom's insurance company. (edit) hmmmmm....after re-reading this thread several times over, I am thinking it can't hurt to contact insurance commissioner office now, particularly since neurosurgeon's office has come up short with the insurance company after their attempts....perhaps the insurance commissioner's office could at least begin by offering suggestions of what you can specifically do "in good faith" before they get involved: could save alot of your time and guesswork on this. Hope this helps. Linda Quote Link to comment Share on other sites More sharing options...
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