My sister isn't going to have her shot.

[aquart]

She has health insurance thru her husband's job. The pain doctor recommends she get a shot in her spine. But her insurer has just sent her two large bills for other things she thought were covered. She had an appointment to get the shot that might ease her constant pain and enable her to walk without a cane, without crying from the pain. But she cancelled it.

Her husband was out of work nine months last year. She's terrified of getting behind in bills in case something happens again.

SHE IS INSURED. But she isn't going to have that recommended shot.

Maybe we will have health care instead of simply the myth of health coverage in this country one day. Maybe my sister will get the chance to walk and be a productive human being again. How long do you think it will take?

[ayeshahaqqiqa]

1. And conservatives say the health bill will result in rationed care

We have it right now. Has your sister tried acupuncture for the pain?

[Christa]

2. Let her call the insurance

She must call and find out if the shot will be covered. She has to get the date and the name of the person she is talking to. If it is indeed covered,s he has to insist that they make a note on her file.

I hope she gets the shot. I have back problems and I know the shot can bring some relief.

[pinto]

3. Damn. Did anyone check w/insurer to see if it's covered? I suspect the MD's office would do that.

If not, maybe she could get someone to act as an advocate for the phone calls, paperwork, etc.? It may only take a phone call, perhaps a fax from the specialist recommending the medication...

[Fridays Child]

4. The absolutely insane part of this whole mess is that the tea baggers and town hall disruptors...

...are every bit as victimized as the rest of us. They have just as many horror stories of insurance company decisions resulting in their continued suffering or the suffering, or death, of loved ones. Yet they willingly submit themselves to the vicious attacks of rabid weasels like Limbaugh or Beck and Hannity and, well, pretty much everyone on Fox News.

We simply cannot allow their sickness to be fatal to all of us. We need to keep talking, keep telling our stories, online, in the papers, in person, on the radio, wherever and whenever we can. This needs to come before everything else. Our lives depend on it.

Light to your sister.

[proud patriot]

5. I so understand

I have medical bills from my sons care ..
Things I thought were covered because we have
insurance .. Blue Cross of California gets 12,000
dollars a year on My family's behalf .

Always screening calls , last time I answered I was
told I was an "irresposible parent" by some hospital
bill collector . :cry: I work with disabled children
you'd think they pay us a living wage ..

Those of us with insurance have some horror stories too.

[unapatriciated]

10. I fought California Care for years during the 90's - 2001.

what really sucks is when they approve a claim, pay it and then months later do a "review" and take the money back. Read up on the 'Fair claims Practice Act' passed in the early 90's to make sure they are not illegally denying payment. File a dispute in writing, requesting a written denial and reason for that denial. If they refuse to put it in writing it's a good chance that it is covered. Read your benefits package front to back, they count on you not knowing what is covered.

I have been where you are, don't give up. :hug:

[proud patriot]

17. Thanks for the words of advice and encouragement

I can't give up , I have to take care of my Son's condition .

I will continue to do my best it's all I can do .

[unapatriciated]

18. I'm not sure if it applies but in some cases medi-cal will cover what your Insurance doesn't

My Insurance didn't cover durable equipment, so Children's Los Angeles appointed a social worker who made sure that he got the walker and other things he needed that I couldn't afford. This was after my divorce so I was in a different income bracket.
Before the divorce I didn't qualify for much except debt.
If I can be of any help when it comes to fighting the 'Blues' let me know. There are a few good books on the subject written by a damn good lawyer who gave me a lot of free advice. I'm sure you can find them at your library.

http://www.shernoff.com/lawyers/WilliamShernoff.html

on edit: It's insane how we have to educate ourselves on Insurance law just to get the coverage we paid for.

[renate]

6. I'm so sorry

It is DISGUSTING that anyone should be in pain that could be relieved, simply for financial reasons.

[phantom power]

7. She's "insured" the same way somebody working 3 part-time jobs is "employed"

The GOP wants to give everybody a big shit sandwich and tell us to be thankful we've been "fed."

[petersjo02]

8. I've had the injections into my spine that you refer to.

Medicare paid for them without any questions. Had a series of three on the left side of my lumbar spine, got by with just two on the right side of lumbar spine (three is the most you're allowed). My back pain is gone and I've been able to resume an exercise program for post-grad cardiac patients at a nearby hospital. It is so wonderful to have my legs work properly and be free of all the pain and aggravation I lived with for two years. Talk to your/her orthopedic surgeon. He may have some ideas about how to get the injections paid for by insurance or he may be able to help work out a reduced charge for them and also a workable payment plan. It is worth asking about anyway. If she doesn't start being a "squeaky wheel," her efforts to get better are doomed. so nothing ventured, nothing gained.

[Fridays Child]

14. WTF! A government-run health plan provided the care you needed?

Aquart's story and yours must be told together.

Loud and clear.

Over and over.

[ShenandoahAspen]

9. my heart goes out to your sister.

Her story is a reminder that it isn't only the uninsured who needs help -- it's the underinsured as well. I send good vibes to her, and hope she gets the help she needs for her pain.

[Taitertots]

11. Best Health Care in the world my ass

Everyone in America is terrified of being sick. Even the people with insurance are fucked if they ever do get sick.

The only people who like it are ideologues, and healthy insured people.

[Warpy]

12. It would be nice if she had the procedure pre approved

in writing, but no insurance company is going to do that for her.

I would suggest she have the procedure. It is in common use now, can dramatically improve pain and mobility, and will give her the energy to fight the bastards if they refuse to pay.

A letter to the state attorney general will get results if nothing else will.

[murielm99]

13. That is unconscionable.

No one should have to live in pain. No bureaucrat should get to decide who should be pain free.

Earlier this year, I was a bit worried. My husband's work was slow. He was laid off for a few weeks every month. If he did not worked at least one day in every month, we would not have insurance coverage for the month. Then, it would take another thirty days to kick back in. It does not matter that he has been at the same company for more than twenty years.

It is good insurance. They have paid for our care when we have needed it.

But I have a medical condition that requires several medications. I have to see a doctor a few times a year and get labs, too. My condition is stable. I am fortunate. But the costs for simply keeping me healthy are shocking. If we had to pay them ourselves, we would be much poorer. I talked about going without my meds and health care if that was what it took. A couple of friends suggested that instead I talk to my doctors and see what could be done to ease the costs. I guess I would have done that. Fortunately, it did not come to that.

I understand the people who choose not to go to the doctor or the hospital. Damn the greed of these insurance companies, and the petty clerks who hold life and death decisions in their unqualified hands.

[Hansel]

15. I'm getting the 2nd of 2 of these shots this week.

My insurance company has no problem with them. This is the last hoop I have to jump through in order get the operation all of my doctors and physical therapist are certain is inevitable. Only one more month of chronic pain.

She needs to check with her insurance company and find out if it is covered before rejecting it. However, is it possible that she is avoiding the shot and it's not really about it potentially not being covered? It is not a very pleasant experience and is painful. After all, they are shoving a needle and a significant amount of drugs into the sleeve surrounding your spinal column and the potential for something to go wrong is very real.

[Fire1]

16. I don't know but I'm going to a town hall meeting Tuesday!! n/t

[puebloknot]

19. Well, this is America. Her pain is going to be alleviated incrementally.

No sense rushing things. Joe Lieberman, et al. feel that we need to wait until our economic crisis is over.

(This story makes my blood boil.)

[Hatchling]

20. Medicare for ALL!

I'm getting my second shot this Friday, paid for by Medicare. My Ortho (completely paid for by Medicare) gave me the name of my Anesthesiologist for which I didn't need a written referral due to Medicare coverage.

I'm also going to Physical Therapy, although there is a limit on how much PT you can have in a year unless it is required for after surgery. Still the amount of PT I am allowed is completely covered.

This month I had a bone scan, a blood draw for thyroid, a pneumonia shot and an MRI with contrast. I paid $20 for my 10 prescriptions. Medicare again.

Yes, I live at the poverty level with my meager Social Security check and my disappearing (thank you very much, Govenator!) SSI check but I am rich in Medical Care.

I, however, am in agony over the pain those without my benefits have to endure. It's not fair, it's not right that you are not getting the same benefits I am getting!

:banghead:
:cry:
:mad:

[Beaverhausen]

21. Have her primary or the pain doctor resubmit. This happens to my fiance

he has been getting these shots in his back, and often the first submission of the insurance coverage will not go through. The doctor resubmits with more info and they eventually approve it.

It sucks, but you have to do it with some companies.