michellep Posted July 9, 2009 Author Share Posted July 9, 2009 Well, went over to the office and it was not pleasant. They gave me a copy saying that 10 nursing visits have been approved HOWEVER it was dated today which is July 8th stating that all visits must be completed no later then July 15th. That's it.....I'm finished begging for anything. I took a few hours once I came home and have decided that I will sell anything and everything we own to take care of him myself. We are lucky in the respect that our home is fully paid for, but sad to say it's only worth half now. But, I don't care....the one and only thing that matters is my husband. I'm thinking that I will call private companies and just go from there. I feel like they are trying to force me my denials into calling hospice, but geeeeeeez we just started chem two months ago and don't even have a progress report yet. I don't know.....all I can say is that I'm trying. Quote Link to comment Share on other sites More sharing options...
RandyW Posted July 9, 2009 Share Posted July 9, 2009 In addition to this one... http://www.patientadvocate.org/help.php?p=186 Maybe this link will prove helpful?? http://clarkhoward.com/ Clark is a consumer advocate and knows a lot or finds out a lot about anything. I don't know if it will help or not but worth a shot though!! Quote Link to comment Share on other sites More sharing options...
michellep Posted July 9, 2009 Author Share Posted July 9, 2009 Thanks Randy....I'll check these sites out and see if they can help in anyway. Michelle Quote Link to comment Share on other sites More sharing options...
Katy66 Posted July 9, 2009 Share Posted July 9, 2009 Michelle, I had started a reply back yesterday saying that I wondered if this was their way of "forcing" you into Hospice...Just wrong. I actually work for an organization that includes a hospice home care and solace center. This is not how someone needs to decide that is the level of care they need. Quote Link to comment Share on other sites More sharing options...
Nick C Posted July 9, 2009 Share Posted July 9, 2009 Most ins companies hhave nurses on staff who work as patient advocates...perhaps this is your first route. Initially the insurance co refused to pay for half of my mother's double mastechtomy because she only had one tumor...the patient advocate got them to pay for the whole thing. Also, the hospital SHOULD have someone on staff who can help you as part of their programs. Quote Link to comment Share on other sites More sharing options...
jstdzy Posted July 9, 2009 Share Posted July 9, 2009 Way to go Michelle! At least you got 10 visits out of them! Now you just need to keep going!!! Go GET 'EM!!!!!! Dana Quote Link to comment Share on other sites More sharing options...
michellep Posted July 9, 2009 Author Share Posted July 9, 2009 I wish I could get all 10 of the visits....the approval says "all" must be used within 7 days......impossible! They knew exactly what they were doing when they generated their so-called approval. I will most likely only be able to get one visit before July 15th. Quote Link to comment Share on other sites More sharing options...
jstdzy Posted July 9, 2009 Share Posted July 9, 2009 Hey! Maybe you could talk to the people that will be working with your husband and tell them the whole situation. Could they just go ahead and bill all 10 visit between now and the 15th? They would get paid and you could see if they would spread the visit out a little more? Just a thought! Dana Quote Link to comment Share on other sites More sharing options...
jaminkw Posted July 9, 2009 Share Posted July 9, 2009 I know I juggled dates for people when I was a counselor. Hey the insurance companies are stealing people blind. My clients were who counted. And like you say, I got paid and the client got the services he/she was paying for. Judy in Key West Quote Link to comment Share on other sites More sharing options...
ts Posted July 10, 2009 Share Posted July 10, 2009 I'm trying to remember how old your husband is - over 65? Just because you have private insurance doesn't mean you can't use Medicare as well. If I am right, here's a link to their policy. If you aren't eligible, someone else might find it helpful. http://www.medicare.gov/Publications/Pubs/pdf/10969.pdf [/url] Quote Link to comment Share on other sites More sharing options...
michellep Posted July 11, 2009 Author Share Posted July 11, 2009 I think I've finally gotten them GOOD and I have all of you to thank. According to Federal Law....all HMO's must provide a medicare patient with the exact same benefits. Now....from what I have been told today from State and Federal contacts is that Blue Cross had created a major problem for themselves by denying my husband home health care that his primary care physician stated he needed. (So far I have that in writing). The only issue I am running into now is "written proof" of the denial itself in order to proceed with my complaint which they require. The medical group has danced around my request for a few days now. I am hoping that the primary care physician will be able to provide that to me. I didn't bother him today because the poor man has food poisoning. ( oh good lord...I hope he doesn't need assistance from the insurance group ) I will indeed call Monday morning and see what I can find out. I would have asked his staff to send me the request, but they don't quite understand what I need so waiting till Monday is best. Thanks and Good Bless all of you for your help!!!!!!!!!!!! Now I'm off to have a very well deserved glass of wine!!!!!!!!!!!!!!!!!! Quote Link to comment Share on other sites More sharing options...
jaminkw Posted July 11, 2009 Share Posted July 11, 2009 Wow Michelle, it's been a tough run but the checkered flag is in view. Good for you girl. Hope you enjoyed that glass of wine (or maybe two or three would have been o.k. lol) Judy in Key West Quote Link to comment Share on other sites More sharing options...
jstdzy Posted July 11, 2009 Share Posted July 11, 2009 Yeah Michelle I knew you would kick their *ss Quote Link to comment Share on other sites More sharing options...
Patti B Posted July 11, 2009 Share Posted July 11, 2009 Good Job, Michelle!!! They know not to mess with you again!!!! Hugs - Patti B. Quote Link to comment Share on other sites More sharing options...
michellep Posted July 13, 2009 Author Share Posted July 13, 2009 Filed an appeal with Blue Cross with 3 day process time. Then I have been in contact with the Dept of Managed Health Care...HICAP advocacy as well as Patientadvocate.org. While waiting I took my husband for a scheduled ultrasound this morning. He was not happy about it since he didn't sleep well last night and could not eat before the procedure. Well, we finally got there only to be told the medical group has "denied" the procedure. uggghhhhhhhhh Upon leaving this place I decide to pick of his medications from the pharmacy......bet you can't guess huh? Again DENIED...and again I'm putting another $600 on my credit card. Still no return phone calls from them about the unpaid anesthesia bills or the ambulance trips. I'm actually holding up well under the circumstances. No tears this time...just sheer anger with these idiots. Maybe I'll have to take another rider over there this week. I wonder if they'll make me go outside to talk again! ha ha This time I'm prepared with a tape recorder! It's hard now, but I know we'll come out of all this just fine. Doubt those people at the medical group will though Quote Link to comment Share on other sites More sharing options...
Patti B Posted July 13, 2009 Share Posted July 13, 2009 (((((((Michelle))))))) THIS IS ABSOLUTELY Bull-@@@@!!!!!!!!!!!!!! How can they do this??? I am so mad right now I feel like coming out there and denying them a few things!!!! Once again, I think calling your state representative or congressperson may help. I have known many people who got things done that way. Glad you are in fighting mode - YOU ROCK!!!!!!! Don't let the idiots get you down!!! Hugs - Patti B. Quote Link to comment Share on other sites More sharing options...
jaminkw Posted July 13, 2009 Share Posted July 13, 2009 OMG Michelle, I am so sorry. I'm glad you are holding up like you are though. Don't know if I could manage to not totally lose it with those people. Oh, you probably have lol. Hang in there and come here and vent whenever you can. Judy in Key West Quote Link to comment Share on other sites More sharing options...
michellep Posted July 14, 2009 Author Share Posted July 14, 2009 "Patti B"](((((((Michelle)))))))THIS IS ABSOLUTELY Bull-@@@@!!!!!!!!!!!!!! How can they do this??? I am so mad right now I feel like coming out there and denying them a few things!!!! Once again, I think calling your state representative or congressperson may help. I have known many people who got things done that way. Glad you are in fighting mode - YOU ROCK!!!!!!! Don't let the idiots get you down!!! Hugs - Patti B. PATTI! OMGGGGG When I read your post I thought....what the heck...try. Within an hour look at the email response I got: Good Afternoon Michelle, Senator Runner asked me to contact you regarding your husband’s medical care. I would like to direct you to the Patient Advocate’s Office in the Department of Managed Health Care. The website is http://www.opa.ca.gov/ Their telephone number is 1-866-466-8900. We have found them to be very helpful in the past. If you have any other questions please feel free to call me at (661) 729-6232. Regards, Lisa Lisa Moulton, District Director Office of Senator George Runner 848 Lancaster Blvd. Lancaster, CA 93534 P-( 661) 729-6232 F-( 661) 729-1683 And Judy.....don't let my posts fool ya but I must admit that I'm better than I was last week....this is war! ha ha No more tears out of me with these people! Quote Link to comment Share on other sites More sharing options...
Patti B Posted July 14, 2009 Share Posted July 14, 2009 OMG Michelle- I am so happy. Maybe they can even investigate these jerks. Just because you have the guts and the fight to go after them doesn't mean everyone does. Just think of the poor people who just gave up!!! Let us know what happens next!!!!! Its like a soap opera on TV, isn't it. But I know you will come out the victor!!!! They will be sorry they ever messed with you!!!! Hugs - Patti B. Quote Link to comment Share on other sites More sharing options...
RandyW Posted July 14, 2009 Share Posted July 14, 2009 If ya tape the conversation make sure to tell them !! They can tape your conversation on the phone so you should be able to do the same thing!!!! Quote Link to comment Share on other sites More sharing options...
jaminkw Posted July 14, 2009 Share Posted July 14, 2009 Michelle, I know all your friends here on the siti (and off) are proud of you. It's not easy to buck the system. It takes a lot of energy. Good for you! Keep us posted. We all want to see the "little guy" win. Judy in Key West Quote Link to comment Share on other sites More sharing options...
Katy66 Posted July 14, 2009 Share Posted July 14, 2009 Michelle, WOW! Great work on your husband's behalf. I can't imagine the added stress of being denied healthcare you need. You keep fighting girl....we are proud of you! Quote Link to comment Share on other sites More sharing options...
trishnmiller Posted July 15, 2009 Share Posted July 15, 2009 I have been following your saga and re-living our battles with the doctors and the insurance companies..all I can offer is do not give in. You will win. They depend on exhausting you and kicking you while you are down so you will go away. They are going to lie about the denial or you would have seen that denial paper by now. You have the record here for reference. I ended up using my own rants to remind me what I had been through. Call the pharmaceutical companies and tell them that you are being denied coverage. Take video of your husband's struggle. Offer it to your local "action" reporter, call the insurance company everyday to remind them that you will need more home health and , as was suggested, record all calls. It was a battle but it didn't kill me and it surely made me strong. You are doing great so just keep it uper! Bless you, Trish Quote Link to comment Share on other sites More sharing options...
michellep Posted July 15, 2009 Author Share Posted July 15, 2009 For ALL! Thanks for your advice....I will never EVER stop fighting for my husband. And thanks to all of you for your help and support. I can honestly say that if it weren't for all of you I would have had a total breakdown by now. I got a call today regarding the complaint I filed with the Dept of Managed Health Care. They said that they handle laws broken with Ins Companies for "non seniors" and that I need to go somewhere else. They say that based on information provided to them, a Federal Law has been broken. So, I will contact this other place and keep all of you updated. There are so many issues in this thread that I think are important to ANYONE who has issues with insurance companies. I hope that we can continue this saga I have going so that others can benefit from it as well. And a special note to Trish...I read about your husbands journey and my heart goes out to you...You've had a long run of this terrible disease and I wish you....just as everyone here HOPE, STRENGTH AND COURAGE....THEN....SURVIVAL. Quote Link to comment Share on other sites More sharing options...
michellep Posted July 16, 2009 Author Share Posted July 16, 2009 The phone wouldn't stop ringing yesterday! First call was from the insurance company regarding my appeal. It was ruled in our favor YEAAAAA ..... Then Medicare called saying that a formal investigation has begun into the medical group........then the nursing group called and said they received approval for eight weeks of 2Xweek nursing and 2Xweek physical therapy! The nurse was here within 2 hours and gave my husband a great physical checkup. I am BEYOND thrilled and I owe it all to the people here who have given such great advice and soooooooo much emotional support. I can't thank you enough. Finding all of you has been wonderful. Oh.....and one experience we had on chemo day I wanted to share with all of you. When we arrived it took a while of course to get my husband out of the car, into the wheelchair and over to the elevator door. Well, guess what? The elevator was broken down and the only way up to the chemo room was to climb two flights of stairs! I just kept thinking....oh my GOD! Now what? Well, the chemo nurse told me that it had been broken for two days and suggested we re-schedule. That was NOT acceptable to me...I know it wasn't their fault because they had been calling and calling for service. SOOOOOOOOOO I pulled my cell phone out and called 911. They sent paramedics out who put my husband on the gurney and carried him up those two flights of stairs and into the chemo room. The patients who were there (that were able to walk up there) all applauded and said.....Great Job! There was no way I was going to have him miss an appt that is so physically draining for him to get to in the first place. I know some might think that by calling 911 it was extreme but I don't agree. We have been fighting so darn hard for everything in this journey of ours that I'm at the point now where I won't let anything stop us from saving his life.....not even a lousy elevator! Thanks again everyone! Quote Link to comment Share on other sites More sharing options...
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