Discussion in 'Fibromyalgia Main Forum' started by mhammie, Aug 10, 2005.

  1. mhammie

    mhammie New Member


    I read your post on Sue's Colonoscopy. I also responded to her post, regarding my experience.

    Your question about seditives "Is this something new? Or, are my health care providers barbarians?"

    It may not be your health care providers fault that you were not given anything. It may be your insurance company.

    When I received our explaination of benefits on my colonscopy, I was shocked to find out they were not going to pay for the drugs used for the procedure. When I called up my doctors office to make payment arrangements for that part of the bill, the billing dept. told me the doctor was going to write it off.

    She explained that some insurance companies don't think it's necessary to have the drugs, so they won't pay for them. I started to say something like the person who made those... I stopped in mid sentence. "The billing person said I know what you were going to say. The person making this decision at the insurance company should have this done without drugs. Maybe then they'd change their mind for the patient."

    She read my mind. Anyway sometimes the insurance companies are the ones at fault for the decisions are doctors are forced to make.

    My sister and her family are in that predictiment, and have been for the last 2+ yrs. When I responded to Sues' post, I explained that my 10 yr. nephew had died from colon cancer. My sister and her husband & other 2 children need to be checked. Their insurance company sees it as an unnecessary screening. The doctors have written the insurance company, but it has been a losing battle.

    I hope you don't have to have another colonoscopy again anytime soon. You may want to check with your insurance company, to see if they pay for the drugs during the procedure. If they do pay, I would certainly be asking my doctor, to give you something the next time.

    I hope your results were good. Take care.

    [This Message was Edited on 08/10/2005]
  2. fivesue

    fivesue New Member

    but what you wrote was incredible! The drug thing is horrible, but I do remember your 10 year old nephew dying and was shocked, and now I am outraged that the insurance company won't pay for the rest of the family to be checked. What's going on?

    This is past the limit. I think if I were your sister I would write to my congressman and explain the situation...this just can't be. There is a clear need for these people to be examined.

    You were right about not any one age...I pray your sister's family can be checked soon.

  3. mhammie

    mhammie New Member


    Thank you so much in responding.

    I don't mind that you read the post.

    Actually I think the more people realize that colon cancer it just something older people get the better.

    That way if there is any family history, they will see how important getting checked is.

    Colon cancer is one of those cancers that usually isn't caught until it's spread. That's why people are so stunned to find out my sisters dilema with the insurance company.

    If anyone else in her immediate family would die from this because the insurance company wouldn't check them, I personally will make sure the story goes to the media. Of course the insurance company will put the blame back on my brother-in-laws employer. Insurance company says it's because the employer has the plan setup that way. Insurance company or employer, someone would definiately be at fault.

    You'd really think the insurance would look at the long range picture in terms of dollars. It's sure alot cheaper for colonoscopy and early treatment, then to pay almost 1/2 million dollars, in hospital & doctor bills, and then still lose a loved one.

    I guess common sense just doesn't fit into the insurance companies plan.

    Thanks for listening Sue. Didn't mean to go off on a tangent.

    Hope you don't have to have another colonoscopy for a long time.

    Hugs back at ya
  4. ceili

    ceili New Member

    who is the insurance carrier that is at fault?!
  5. mhammie

    mhammie New Member

    Blue cross/ Blue Shield with Walmart as employer
  6. TXFMmom

    TXFMmom New Member

    I was a medical professional for 26 years and I hate insurance companies.

    We had Aetna at one time and they were giving me a hard time. I asked the young woman who had refused a referral what the symptoms I was having meant to her and what they might indicate. SHE DIDN'T KNOW. That's when I asked her what Nursing School she attended and what her Nursing License number was. She said she wasn't a nurse, had no and I mean NO MEDICAL TRAINING. I ripped her a new one.

    Told her I was an Advanced Nurse Practitioner and she was making decisions RN's couldn't make, you had to be an ARNP to make them. Also asked for her supervisor's name and that person's supervisor, as I was reporting them to the Nursing Board, and I knew how to report what she had said, what I said, what she and her supervisor's were doing, and that I would personally file charges on all of them. She started crying and said she was just following orders and I am ashamed to tell this, but my retort was that it didn't work for the Nazis and it wouldn't work for her.

    My doctor called me an hour later, laughing, wanting to know what I had done to Aetna, as they had called back giving permission, crying. His nurses sent me flowers.

    However, if you have an insurance company who is denying something, do the research, list why you need it, have your doctor sign a copy, and SEND IT TO THEM CERTIFIED, NOTIFYING THEM THAT YOU ARE GOING TO REPORT THEM TO THE INSURANCE COMMISSION OF YOUR STATE AND TO THE MEDICAL BOARD OF THE STATE.


    Usually, that is enough, to get them to do the right thing.

    I once had to appeal everything all the way up to their medical director. This pompous jackass finally called me back, and went into this spiel, I told him and I am quoting to cut the crap, I was an Advanced Nurse Practitioner, and a Certified Registered Nurse Anesthetist and had been for years and that if I didn't receive the right and indicated CARE IMMEDIATELY, then I would sick the Nursing Mafia on him. He knew EXACTLY WHAT I MEANT.

    Don't let these insurance companies shaft you.

    There are consulting companies which specialize in getting referrals and treatments through insurance companies and they know their stuff. Ask your doctors for a referral.
  7. Mikie

    Mikie Moderator

    This holds true with insurance companies. Become their worst fear. Go through all the grievance procedures and if you still don't get what you need, threaten to turn them in to the state insurance commissioner's office. That usually does it.

    Love, Mikie
  8. suzetal

    suzetal New Member

    Its the employers fault. When they pay a portion of an employees benefits they cut back and take the cheapest way out.
    I was an assistant for Wal- Mart and the ins. they offered had a huge deductible for all your medical .For an existing medical problem you could not use it for one year.
    I did better paying for my own insurance . They covered every thing.
    Good luck to your family.
  9. fivesue

    fivesue New Member

    We have a wonderful source here in tsfmmom as she knows the ropes. Sounds like she has the proper way to get things done. I hope this will help your family. We certainly don't want to have another illness and more suffering. Hopefully your family can use this information to get results.

    Don't worry about venting...we all do it, and it's OK....OK! That's one great thing about this board. You can vent and we understand because at one time or another, we all vent...we have to...look at what we're dealing issues, insurance companies, disbelieving doctors, ignorant public (just not educated about FM, not stupid...), some critical families...guess you have a reason to vent at times. If the top of you head!

    Take care...

  10. mhammie

    mhammie New Member

    Thank you everyone for all your care, concerns, & suggestions, and also for being here to listen. It sure means alot.

    I think my sister has pretty much given up the fight on getting the colonoscopies approved by their insurance company. She has so many tough days. It's been 2 yrs. come Sept. 2 that she lost her little boy.

    I think fighting with the insurance company is something she just can't cope with right now. I hope that one of these days, she & her family will go for counseling. They have been trying to deal with the grief on their own.

    I will certainly bring up getting the insurance commissioner involved in their situation. If she won't do it, I hope she will give me the go ahead to at least call the insurance commissioner. There certainly has to be someone that can do something. It's just a matter of finding out who it is.

    My husband was forced to change to BC/BS this year. Sometimes I really do think it's the employer that can make things tough. Of course my husband has a pretty good employer. Hope he never looses his job. This yr. his company paid the 1st half of our deductible. His premiums are alot lower than friends of ours that work for other companies.

    BC/BS always pay our claims very quick. Alot quicker than Midlands. I had to fight with them for over a yr. to get some claims paid. Thankfully as long as I kept the hospital updated, they didn't constantly send us bills or harass us. Keeping on top of our insurance problems 2003 became a full time job. Thankfully I had quit working.

    I normally have low blood pressure. Last time I had to talk to a rep. from Midlands was right before my doctors appt. Needless to say that day my blood pressure was running way high. I just wanted to reach thru the phone and grab that woman by the neck. Just a very dense person.

    Txfmmom, please tell me what the nursing mafa is??????

    Glad to know it's not just my sister & I that truly hate insurance companies. I think sometimes they give us the run around just because they know a person can't survive without insurance.

    Everyone take care!!!!!!!!!!!!!!


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