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Good1 #89454 02-04-2009 04:37 AM
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CherylR Offline OP
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I'm doing a lot of ranting lately......got the pet scan straightened out and now the disability insurance carrier has decided to close the claim because they didn't get whatever they wanted from the docs. Seems the docs are playing pass the buck with the paperwork. Spent 45 minutes on the phone with the insurance people yesterday, then went back to work and faxed them 12 pages of stuff I already had. We'll see where that gets us. Haven't even seen a bill for the medical yet although the dental extractions were a fun bit - our insurance pays $2500 on dental per year and the bill was $5300. I pointed out that since extractions were due to medical reasons NOT dental that maybe they should submit to both dental and medical carriers. I've yet to see anything from either one. There's another call to make and probably another 45 minutes. Bill the insurance!!!! Why do they think we paid for it!!! (And just as a side note, I'm attempting to deal with my mother's Part D Medicare coverage for prescriptions - she's covered by insurance through retirement benefits that won't pay except when she's in the "donut hole" and now they (the retirement carrier) seems intent on mailing that back and forth to us from various places around the country----grrrrr......)


CG to H with SCC BOT T4N2cM0 dx 12/19/08, teeth removed pre-tx; Erbitux & RT-done 3/12/09, PEG 2/9/09-7/14/09; ND 6/16. Pet 6/12-no mets except lymph node in neck removed on 6/16. Chyle leak,2nd surg to repair. Dilate esophagus 4/15/10. Clear PET 12/17/10
CherylR #89455 02-04-2009 05:35 AM
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Comment to me from an independent insurance agent who once worked for a major national insurer: "The insurance companies are the closest thing to the mafia we have in the USA."

In addition to all the above comments about health insurance and having fought post Katrina battles with both home owners and FEMA based flood insurance from the same company and knowing what many of my friends have gone through and the battles still being fought, my impression is that all insurance operates under the same rules as the Red Queen in Alice's Wonderland.

Malka,
another guest at the Mad Hatter's tea party




SCC stage II Partial mandibulectomy w. neck dissection- July 2005. Renal cancer w. partial nephrectomy-Jan 2004. Breast cancer discovered in routine mammogram. Successful lumpectomy, sentinal nodes clear, RT only-2008 Reconstruction of mandible w fibula free flap-Jan 09. TORS removal of begnin pappiloma from esophagus-2010. Masectomy,rt breast 2013.
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Malka #89495 02-04-2009 06:58 PM
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Posts: 216
CherylR Offline OP
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Had a better time at the tea party today.....Mike had chemo and RT so I had a lot of time at the hospital. Went to the nurses in both departments and told them what was going on and bless their hearts they hit the print button and gave me everything including the "Monitor Unit Calc Sheet" showing the RT mapping of the tumor! The nurse said they'd never understand it but if they want paper, we'll give them paper. grin I hope I jam the fax machine at the insurance carrier's end with this stuff. I will fax tomorrow from work since I work for an attorney and he's ok'd whatever I need to make this move. Also noticed today that this case manager is located in Lexington, KY....a driveable distance for me....I may offer to bring the tea party to him in person smirk I wonder if any of the people making the decisions on these claims ever meet the claimants in person? or their totally irritated spouses?!?


CG to H with SCC BOT T4N2cM0 dx 12/19/08, teeth removed pre-tx; Erbitux & RT-done 3/12/09, PEG 2/9/09-7/14/09; ND 6/16. Pet 6/12-no mets except lymph node in neck removed on 6/16. Chyle leak,2nd surg to repair. Dilate esophagus 4/15/10. Clear PET 12/17/10
CherylR #90556 02-23-2009 02:40 PM
Joined: Jan 2009
Posts: 225
"OCF across the pond"
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"OCF across the pond"
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[quote=CherylR] I wonder if any of the people making the decisions on these claims ever meet the claimants in person? or their totally irritated spouses?!?[/quote]

Haha, in the uk we are lucky enough that the national health system is taking care of Martin. Although you do sometimes feel like you are only a number or a statistic.
The state however would not give him any support, as i work more that 16 hours a week. I can afford to look after the household. Luckily i have a reasonable salary and I can work from home if need be, but it seems unfair. While working middle income people work hard and try to keep things going, struggle, scrimp and save and make do, some lazy so and sos (not all, just some), don't work and get everything taken care of, allowances, house. It makes me annoyed!
On the other hand, i do think that we are very lucky that our health care is free. i have private insurance through work, but martin doesn't, and he is still getting excellent treatment.
C


Girlfriend to Martin 49 years old at diagnosis
Diagnosed with SCC unknown primary June 2008.
Cancer found in single node Stage N2A (3 to 6cm).
Tonsilectomy 16th june, Radical modified neck dissection left side 30th june.
30 TX radiotherapy ended 9th October
First comparative study scan came back clear
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