My insurance company just sent me a letter today informing me that they will no longer pay

[saracat]

for the treatments that make it possible for me to lead a normal life. I already pay $1300 a month for insurance that now will not treat the very condition I need it for! Without treatment I have a condition which will make it impossible for me to function. I currently have to travel across country 3 times a year at my own expense because there are no local doctors who can treat me.It already costs me more than I can afford. This will double the cost and make it impossible.I guess, as far as hope goes, I have just run out, but I doubt anyone in DC will care.They are also not paying for my last treatment with no explanation why. The treatment was covered when we purchased the plan more than 4 years ago and is a legitimate medical treatment. So much for those who think we all have 'time" to work things out. Oh and "Bitter" ? You betcha! And the insurance company? Blue Cross!

[Ardent15]

1. Sorry to hear that

K and R

[saracat]

3. Thank you, but according to some, I am just selfish to want coverage!

[dflprincess]

7. "Coverage" you got

what you need is access to care. And nothing Congress is doing will guarantee you that.

Find a lawyer in your area willing to sue the bastards and who will help you make as big a public stink about this as possible. Nothing like some bad publicity to make them change their minds.

There was a case here several years ago where the attorney went after a company that was refusing to pay for breast reconstruction after mastectomy. Actually, the woman had "only" had one breast removed and the company would pay for reconstructing one side, but would not pay to make the breasts symmetrical. They changed their minds when the attorney and the patient hit the local news.

[saracat]

9. "Access to care" is right.The thing is most lawyers want something, Even if it just the filing fees

and I just can't afford anything else.But I am mad as hell and don't want to take it anymore, and that goes for DC as well as the insurance companies. I will make the attempt to talk to the insurance people but this is the reason these companies need to be put out of business.They are making decisions that control the quality of our lives or even if we have lives.

[juajen]

24. I'm so sorry, saracat. I agree that insurance companies are

nothing but crooks; and that includes all insurance companies. After I purchased a policy that would only cover cancer and heart attacks, in other words, major medical policy, they refused to cover a heart attack caused by a stent operation. My bill was over 60,000 dollars and I could not get an attorney to touch it because the insurance company claimed a pre-existing condition, that I didn't have; but, they wouldn't touch it. So, I paid all that money for this super great policy and when push came to shove they didn't pay a cent. I do believe we would be much better off without them.

[saracat]

27. Really. They need to be run out of business.They are nothing but corporate leeches.

I am sorry for some of the folks that must work for them but they are evil. Right now it costs me more to get some meds if I use my coverage then if I pay out of my own pocket! And I have perscription drug coverage! WTF do I pay for??? And we wanna mandate this kind of thing for everyone without any cost controls?

[The Doctor.]

82. Working on it.

Please hang in there. Do whatever it takes to take care of yourself.

They love to do things with nice, sterile letters. They really can't handle face-to-face.

[unapatriciated]

99. First thing you should do is contact the govt agency that regulates health ins.

in your area and get a copy of the laws regarding them.(or search for them on the internet).
I know what you are going through I spent over ten years 'fighting the blues (also a very good book)'. California enacted some very strong laws in the early 90's.
Most states (not all) do have laws regarding fair claims practices.
Back up all phone conversations with written documentation.
Read your policy from front to back and use it to your advantage in your documentation regarding what is covered and what is not covered.
It's a lot of work and any help I can be let me know.
William Shernoff is the leading authority when it comes to Health Insurance Laws. His office help guide me in getting my Insurance Company to honor my policy.
I did better than most of the parents I met at children's during my son's long battle with dermatomyositis.
I still lost a lot but managed to get them to cover a lot that they refused.

Shernoff is in California and can't help you in AZ but might be able to point you in the right direction. He has also written a few books that you might find at your local library.
http://www.shernoff.com/

pm me if I can be of any help.

on edit: Here is a link to help you get started
http://www.claims-advocacy.org/how_the_unfair_claims_settlement.htm

[Ken Burch]

96. They're really saying you're selfish not to die.

And a lot of the people who will say that are the anti-choice types. They're "pro-lifers" and "herd cullers" at the same time(note: this statement does not apply to "Seamless Garment" people).

I am so sorry for your news.

We need to build a system where this shit does NOT happen!

Perhaps we'll need people to set up their deathbeds at the gates of the mansions of the malefactors of no coverage.

[FLyellowdog]

2. Call your local tv stations and newspapers

You need to tell your story to the public. I'm so sorry that you have to endure such unfairness. Who is the company?

[saracat]

4. Blue Cross and Blue Shield

[WillYourVoteBCounted]

5. I am sorry. check quickly to see if your state has a "high risk pool"

It might suck, but it might not. There may be a 6 month period where your condition is excluded.

But several states have these high risk ins pools and they might do something.

I wish I knew more.

I don't have health insurance.

Oh, and be sure to let your congressman know about this.

[saracat]

8. I don't think my state has any and there might be problems with my having to go out of state and my

congressman is my neighbor, John Shadegg! He really won't care. But I am going to appeal to the insurance company. For what its worth. And I will look into other insurance if possible.This is why we need a public option that covers everyone.

[nilram]

108. I thought they all did, as a condition of the Kennedy-Kassebaum bill, but

the lists I have links to indicate that that's not true -- not every state has one. Anyway, here are some lists to check for your state's availability.
http://www.gohealthinsurance.com/health-insurance-information/high-risk-health-insurance-pools.html
http://www.theinsurancenation.com/health-insurance/high-risk-health-insurance-pools/

Sucks--most of them impose a pre-existing conditions exclusion,
http://healthinsurance.about.com/od/highriskpools/a/hrps.htm

Sorry you have to fight your insurance company--always happens when we're least feeling like dealing with it.

[gateley]

6. I'd try to get exposure. Write this letter to Ed Schultz. Call your local TV station

who has an advocate where they go out and confront people.

AND, if you can, make a YouTube video like that guy did who had a beef with United Airlines.

Once the light is shining on them, they often apologize for the 'misunderstanding' and reverse their action.

And your congressman/woman.

Really, you have to bring attention to this.

I wish you the best of luck, and please do try to get the word out. They hate negative attention. :hug:

[w8liftinglady]

59. Ed Schultz has been great in his criticism of BCBS-He'd jump on your letter...

[Fire_Medic_Dave]

10. What is the treatment?

[saracat]

13. Spasmodic dysphonia, I have the rare abductor kind that is very difficult to treat.

It is a neurological condition that affects speech. In my case, unlike others , who become strangled or odd sounding,my voice becomes inaudible.I can't use the phone or even pay for groceries.But botox shots to my vocal cords have restored my speech to almost normal. Only one doctor seems competent at treating abductor.

[Fire_Medic_Dave]

18. I'm sorry. That is very interesting.

I have heard of them treating certain types of dystonia with botox. Have you tried to appeal the decision yet?

[saracat]

19. Just got this today! they have paid for this for four years!

[Warpy]

20. I can pretty much tell you what happened to you

Some dumbfuck who's apple polishing and bucking for supervisor by throwing people off treatments they paid for and making his/her numbers look good saw "botox injection" and said "Aha! We don't pay for cosmetic procedures!" and put in the paperwork to deny you this treatment.

I think if you make a stink, you'll get your treatments paid for.

The dumbfuck will undoubtedly get a promotion. They always do.

[saracat]

23. Except that isn't really how it is written up. But undoubtedly there is an element of truth

to what you say. probably some idiot decided tjhat they were unfamiliar with the condition as it is considered a "rare disease" and decided treatemnt wasn't warrented.Maybe they thought it was experimental.

[Lorien]

63. Warpy is on to something. The makers of Botox won't seek FDA approval for off label

uses. I get Botox injections for migraines which my insurance won't cover; my doctor says that Botox only wants the approval for cosmetic uses. It's used off label for many conditions (a friend of mine has injections for her post polio/ carpel tunnel pain) but apparently Botox fears a profit loss if they get FDA approval for the treatment of medical conditions, so all medical uses of Botox are considered "experimental."

[jennied]

78. How would they lose money? Wouldn't they be gaining more money?

[Lorien]

92. That's what I thought; new uses, more revenue

but my doctor says that that's the last thing they want. :shrug:

[Yurovsky]

107. In order to get FDA approval, companies typically...

have to complete 2 randomized trials with positive results (i.e. the drug does what you say it does). The FDA generally waved this during the AIDS crisis of the 1980s, and with many current oncology trials if the data is really compelling.

The cost of doing the trials may not be recouped by the increased revenue, therefore companies decline to do the research. This, IMHO, is why the government needs to take over the drug companies. If we're ever going to find treatments for diseases like ALS or progeria, we can't depend on whether or not Pfizer or Eli Lilly can make a buck off of it.

On a side note, the same insurance companies that won't pay for a drug for an off-label use will often try to get doctors to NOT use an expensive drug with a specific indication and instead use an inexpensive generic that hasn't been approved for said malady.

Who says you can't have your cake and eat it too? The insurance industry sure seems to be able to...

[Lydia Leftcoast]

90. According to my brother the doctor, insurance companies

have a checklist of "acceptable" treatments for certain conditions, and if it's not on their list, they'll deny it. Even if it works. Even if it prevents the patient from needing a more expensive treatment.

[ChadwickHenryWard]

69. What I would suspect is going on

is that they have decided to deny every procedure right off the bat, and only pay for the ones that patients can make them pay for. It's not an uncommon tactic for these rat bastards. I imagine this is periodically done by every company, and our friend here just got caught up in a regularly scheduled purge.

It's important to note here that they are playing games with people's lives. This ain't no fucking joke, but to these people it's all just a game. I think this is what's fundamentally wrong with the American system - everything, even human life, is secondary to profit. And, to tell you the truth, I think that's the number one problem with out healthcare system generally- that it's for-profit. There are certain things that just shouldn't be sullied by the profit motive - the military (ha!), the police, the courts, the fire department, schools, and medicine.

[Lorien]

93. Agreed. I know someone who works in an insurance claims office

and she says that all claims are routinely denied. They only agree to pay if you fight them on it for a good long time.

[Fire_Medic_Dave]

25. Appeal it tomorrow and get your doctor to call them.

[saracat]

26. Exactly what I was planning to do! That is my first step.Sigh. I hate them.

and I hate the bastards in DC!

[robinlynne]

55. You might get an attorney. I dealt with the appeals process once. you can not be present

at the hearing, and unknown doctors paid to deny your treatment make the decision. I would get an attorney involved so they take yous seriously. If you have a contract saying they pay or that treatment, and they have been doing so for years, I don't think they are allowed to change that.

[horseshoecrab]

68. when you call the insurance co.

Saracat...

Ask them to send you the paperwork for both you and your doc to initiate an appeal. Ask for their written policy on off label use and also find out if they now require "Prior Authorization" for this use of botox each time you receive it.

I'm betting that your doc will help you with this. The doc's office staff is often the lifeline in this kind of situation.

It can be done. It's so d*mn disheartening though... As if you need a fight when you're already in a struggle to simply speak. :hug:

I wish you all the best with this!


horseshoecrab

[jwirr]

79. I think if I were you I would argue this on the basis of what it is going to

cost to take care of you when you are dis-functional. That is the way that I got Medicaid to pay for care in the home for my daughter - pointed out the difference between home care $.33 and hour as opposed to institutional care $12 and hour. Now I realize our cases are not the same but I used it as an example of the way to argue.

[amborin]

11. outrageous! the same Blue Cross, aka Anthem Blue Cross, whose recission cases

were too costly for the state of California to successfully oppose....

Anthem dropped people for "fraud" (loosely defined); California sued Anthem, but had to drop its lawsuits for lack of time and $$$$$$

just a taste of what the Senate HCR bill would be like

[cabluedem]

43. The same Blue Cross who threw me into the street with a huge bill they refuesed to cover?

Oh well I just refused to pay for it too. Credit rating is still 715 and climbing. Screw BS/BC the lying thieves.

[eridani]

46. + 10,0000 n/t

[cbdo2007]

12. call the appeals dept tomorrow and tell them you want it paid and that they need

to do an appeal on it.

If they don't pay it again then do another appeal.

If that doesn't work. Move closer to where you can get treatment so it isn't such a financial hardship and figure out how to pay out of pocket.

Sorry this is happening to you.

[ThomCat]

14. I am very sorry BC/BS is playing games with your life this way.

:(

I hope you can appeal. I hope that can do some good.

I know the odds are slim, but that's the only option they allow us, isn't it? And, of course, the reason they aren't covering you any more, whether they admit it or not, is only because it costs them money. They know it's a legitimate medical expense. They know it was contractually covered and there is no moral or ethical reason to stop paying for it. But their bottom line is so important that they'll game the system and fix the rules so that they're allowed to re-write contracts at any time.

:grr:

I hope you can find a solution. Please be well! :hug:

[cabluedem]

44. BLue cross fights most appeals like tigers on a piece of meat, which is what we are to them. nt

[CoffeeCat]

15. I am so sorry about this...

...because it is very stressful when you're dealing with big companies that have
your health in their hands. I think we are going to see more of these abuses, as
these big insurance companies know that they've got our government in their pocket.

I know it must be hard to think about putting up a fight, but have you considered doing
what others are suggesting? Really raising a stink about this and fighting in the media
spotlight? You can call on local media (television and newspapers) and you can also use
social media (Facebook, Twitter, You Tube) to your advantage as well.

Blue Cross has a very sophisticated PR department. They put a great deal of money into
protecting and managing their reputation. I know people who have worked in PR for them...I
worked in PR for many years. BC thinks that you will slink away quietly. If you appear
to be someone who will raise hell--they may consider the damage to their name more costly
than continuing your treatments.

I can give you advice about how to contact media and help you write a press release and do
some things with social media, if you like.

[saracat]

16. Thank you. I sort of know how to do that having experience in media

but never for anything like this.It is sort of overwhelming at the moment.

[sdnewbie]

17. :(

I am very sorry to read this..my heart goes out to you

[marybourg]

21. E-mail Dianne Rehm at NPR . She suffers from same disorder,

takes time off periodically and publicly for treatments and mentions it very frequently. Maybe she can help you shame BC BS publicly or find you a local doctor; she has a lot of contacts in the medical field. Good Luck!

[saracat]

22. Diane has a different kind than I do .She and RFK have adductor .it is much more easily treated.

There is really only one doctor , who pioneered the treatment of abbductor, who can guarantee treatment and that is the one I see.Thank you.She might be a good ally though!

[KamaAina]

94. You know who else has it? Sen. Susan Collins (R-Her Vote Makes It "Bipartisan")

Seriesly.

[TexasObserver]

28. The problem you experience is one many in the debate don't understand.

Ultimately, no insurance policy can guarantee you will get the treatments you need, because an insurance company is the SOLE determinant of what they honor and how long they honor it. They now want you gone as a customer, so they'll find a way to make your payments to them larger than your claims paid by them. They don't want to pay for treatments. They only want customers who require less health care than they pay in premiums. This will always be true of for-profit medical coverage. You use it too much for them, they'll find a way to screw you.

This is why we don't need health insurance, we need universal health care, end of story.

[saracat]

31. You nailed it.

[raccoon]

52. Great post. Please consider starting a thread with this. nt

[Beaverhausen]

29. I'm so sorry to hear this

It sucks. Are either of your senators any good with this kind of stuff?

[saracat]

30. LOL. Kyle and Mccain????????

[Beaverhausen]

33. oh crap. Well you know, they SHOULD hear about it

well, the person who answers the phone in their office should. This is exactly the kind of thing those two bozos need to hear about.

[saracat]

35. I can try but likely the person on the phone cares as little as their boss!.

[IndyJones]

32. I think you need to call your Senator's office and have them call on your behalf.

They are there for these types of things and it can make a difference. Please call your Senator tomorrow and explain the situation. Ask if they will call or write a letter on your behalf ASAP.

This is not right. I'm sorry this is happening to you.

[saracat]

34. My Senator is McCain. the other is Kyle. Blue Cross owns them.

[NuttyFluffers]

36. try Mexico expat medical insurance and care. might be cheaper! :)

hope things work out! keep your eyes peeled for options! :hug:

[democracy1st]

37. I'm speechless right now ...

[mdmc]

39. these kind of stories make me so mad

I hope the OP can get what is needed..

[mdmc]

38. Its too bad we don't have single payer

the people who made the decision to cut off your treatment wrote the current hcr bill..

[fujiyama]

40. I'm sorry to hear that

Insurance companies are like casinos.

The house will almost always come out on top. And their tactics are worse than any casino owner out there. They're more like the mob.

[malaise]

41. Who will stop this madness?

:grouphug:

[Tippy]

42. To bad we can't send our medical bills to those who are responsible for this mess....

[GinaMaria]

49. Hmmm..... Not a bad idea actually

for a demonstration/protest. You are on to something. I've got to let this one cook in my brain for a while to see what forms. There's something here... Anything sparking for anyone else here?

[Tippy]

62. It has been something I've been thinking about for a while

threw that out their to see what others thought....Come up with any ideas yet?

[eridani]

45. And there is not so much as a single paragraph in any of the HCR bills-

--that would require any insurance company to honor any claim at all. This horseshit about medical loss ratios is NOT regulation in any way shape or form--it is simply locking the door after the horse gets away. The only remedy offered is that maybe, years after needed care has been denied, you might get a premium refund. 15 states have already tried regulating MLRs, and it has been a miserable failure.

People with pre-existing conditions will still get denied coverage, only it will be called having a lousy credit score. One of the biggest problems of the Senate bill is that enforcement of anything is left up to the states, which means that there will not be any. California already has a law against recissions, but they are not enforcing it because thay can't afford to.

[drm604]

47. Have you tried AHCCCS?

I have no idea if you'd qualify or not, but check out the Arizona Health Care Cost Containment System at http://www.azahcccs.gov/

This page may be applicable to you http://www.azahcccs.gov/applicants/categories/disabled.aspx

They also have a page on health plans. http://www.azahcccs.gov/applicants/healthplans/healthplans.aspx

There may be income limits so you may not qualify but it's worth looking into.

Also check out these Google search results. Ignore the ads, just check out the search results which should all be .gov sites.
http://www.google.com/search?hl=en&q=arizona+health+insurance+site%3A.gov&btnG=Search

[saracat]

86. azahcccs is on the table to be almost completely eliminated

due to our budget shortfalls and a GOP leg and Gov who jumped at the opportunity to downsize it. And no,I wouldn't be eligible.

[DailyGrind51]

48. But, Eric CAntor says that "existing programs" will take care of you?

I am a cancer survivor of nearly 30 years and can't buy private health coverage "to save my life". Fortunately, my employer now covers me under their group plan. I could paper a wall with the rejection letters from "private sector" companies. Republicans can stick their laissez faires up their supply sides!

[WillowTree]

50. Have you checked this out? If not, it sure couldn't hurt.

Good luck.

http://www.dysphonia.org/treatment/reimburse.asp

[saracat]

84. Actually I have but the cost of the botox isn't the problem so much as

the expertise in the administration of the injection. The abductor mucles are more difficult to inject because of their location.Not just any doctor can do it.Even if I were able to get Allegen to provide the botox, I have to have the doctor to administer it.

[Rosa Luxemburg]

51. Visit your representatives in person

contact reporters from local newspapers and radio. Leave no stone unturned. Get family and friends to help you. Go into the office of BCBS and ask who made this decision and why.

[DisgustedInMN]

53. That just plain sucks.

Unfortunately, all you are likely to get from DC is more excuses why nothing can be done and told to STFU. Welcome to the Blue Dog Democrats Health Care system.

(If there's any difference in it from the Republican Health Care system please let us know, so we change it to match exactly.):sarcasm:

[glinda]

54. BCBS is an ass. That is what I have also. You should try everything suggested. Good luck!

[Juche]

56. Sorry

Our system is fucked on so many levels.

What is it you can't afford? Is it the botox or something else? Is there some way you can get it done out of pocket?

I read about a doctor in Las Vegas who got disgusted by insurance companies so he set up his own insurance free outpatient surgery clinic. As a result of not dealing with insurance overhead and headaches, he charges about 1/4 of what most doctors charge. He does hernia and gallbladder operations for about $5000, when most docs charge 10-20k for the same thing.

Point is, maybe there is a place you can go to get the botox out of pocket. Is that the biggest part of your treatment?

[Vinca]

57. Your complaint is so common now and it seems the "powers that be"

never take into consideration the stress of dealing with insurance companies and how it affects the ability to stay/get well. The POTUS has, on occasion, talked about the stress his mother experienced, but at this point words are cheap. We need action. (And serving us all up on a gold platter to big insurance isn't what we need.)

[Lorien]

65. +1. nt

[Cleita]

58. I don't know your condition, but sometimes Medicare picks up treatment

for chronic conditions that insurance won't pay for. It will cost you a lot less per month than what you are paying now as well. It's worth looking into. Medicare has a website that explains it all to you.

[JohnnyBoots]

60. You should find others like you and file a Class Action Lawsuit. Good thoughts and best of luck. NT

[Gormy Cuss]

61. File a complaint with the state insurance department.

http://www.id.state.az.us/consumermore.html

[liberation]

64. The disgusting thing in all this...

... is that if you sent a similar letter, informing your HMO that you will no longer pay your premiums/dues, you would be most likely be put in some legal pickle.

It is disgusting, and we need to grasp the fact that since citizen's rights in this country seem to be for all intents and purposed subsumed with respect to the rghts and protections that corporations enjoy. Thus we no longer live in a democracy, but in a state following an ethos of corporativism. Which is Italian for fascism.

Enough is enough. I know it doesn't help much, but know that reading about situations like the OP's and being married to a medical doctor (and all the horror stories she gets to tell me during the precious little time we get to spend together due to the workloads we have to endure) it just makes my skin crawl with anger and disgust as to how low we have fallen as a society.

[ChadwickHenryWard]

66. One of my profs had a dispute with Blue Cross many years ago.

He sewed up a suit full of magnets, went down to their office, and walked past as many computers as he could. He never got the problem resolved, but he did delete most of their hard drives. I don't know if that story is entirely truthful, but the point is you should not take no for an answer. There must be some way you can fight it.

[AllyCat]

67. Saracat, I posted something similar and feel badly because your situation is far worse

than mine. I'm sorry I'm even griping. I'm so sorry this has happened to you! I agree with others here...get the media or someone involved. Insurance cos don't like bad press.

[ChadwickHenryWard]

70. You know, I read recently about something called an

"Executive Email Carpet-Bomb," wherein a whole bunch of people send mass emails to the entire executive structure of a corporation, letting them know we won't take their shit. That might be worth looking into.

On Edit:

Here is a link explaining how it works. It's seems like it might take some doing to get all the emails, but if you're determined enough, it should be possible.

http://consumerist.com/2007/05/how-to-launch-an-executive-email-carpet-bomb.html

[Earth_First]

71. You know Saracat, best of luck to you! n/t

[followthemoney]

72. DU AdBot pimps BCBS /nt

[PA Democrat]

73. K & R. I can't decide who I am more angry with.....

the insurance companies or the politicians who do their bidding. It's outrageous that they can do what they are doing to you and millions of other Americans. Please make sure to contact your senators and your representative with your story.

:hug:

[midnight]

74. I wonder how many in congress have to live with this discrimination against

them or their family's health conditions. This just should not be.... It is time to mean business of providing health care, and not insurance care.

[Lance_Boyle]

76. This is not the insurer's fault, it is the drugmaker 100%.

[gleaner]

102. The Pharmaceutical company ....

and its practices are execrable, but it is too the insurance company's fault. They have paid for the treatment in the past and that set a precedent to continue paying for it. It was their decision to stop it now.

I'm not trying to bait you, or antagonize you, but I think it is time that Americans start assigning responsibility where it it due. Everywhere it is due, and to act accordingly.

Blue Cross just ripped her life apart and she can't find any recourse now. I have Multiple Sclerosis, and believe me I know crap when I hear it from health insurance companies, and this is crap.

[Lance_Boyle]

75. Off-label use of an approved drug - I can't believe they paid for 4 years.

This is the drug maker's fault, not the insurer's. It would be trivial, but not trivially inexpensive, to get the drug approved for this use. But the money's not there to push the drug maker to do it. So they opt not to. And insurance will not cover the cost of off-label use of approved drugs. Catch 22. But the blame falls squarely on the profit-driven manufacturer. Sure, they *could* run the trials to get it approved. But they would never recoup the investment as spasmodic dysphonia is so rare, and your variety even moreso. But the insurer has a valid reason not to pay for off-label or other experimental usage. Set a precedent and the door is open to everyone who claims that morphine treats headaches, or EPO makes bicyclists' breath smell better. Catch-22 indeed.

I am sorry for the situation in which you find yourself. Rest assured, the manufacturer knows you will come up with a way to pay for the off-label treatment without help from insurance. And they will gladly accept the *profit* from off-label use. Just not the risk. You have been professionally boned by the maker of Botox.

[greiner3]

77. My mother will be 80, is aging gracefully;

And receives botox for spasmatic dysphonia also. She was in one doctor's office when an office gnome asked her, 'Why do you get botox shots?' I was not there.

[gkhouston]

100. She should have told the gnome that she doesn't like having wrinkly tits.

}( That's probably the politest thing my mom would have come up with.

[Boudica the Lyoness]

80. Blue Cross called the sugery I needed 'experimental'

and refused to pay for it. It was a Total Ankle Replacement. My doctor had a peer to peer talk with them and told them I needed the operation. The alternative was to have my ankle totally fused. (NO WAY). They backed off their original decision and I got my new ankle...I can walk again.
I was going to go for England for the op if they wouldn't do it here. In the US the total cost for the TAR was $60,000. In England, as a private patient it would have cost me 9,000 pounds. ($14,000).

[Lydia Leftcoast]

91. Yes, and the price is lower in England because providers know that

patients always have the PUBLIC OPTION.

[mudplanet]

81. Arrange your finances so that you qualify for Medicade aka "the public option"

[TheKentuckian]

83. I'm sorry Sara. Another case of we why we can't goof around with this game

Building our little starter lean-to on the ever ravenous Sarlacc pit will just result in everyone but the wealthy getting swallowed whole.

[femrap]

85. Scream as loud as you can.....

write your Rep and Senator and anyone else. Call the newspaper with your story. Call USA Today and go national.

Shame the fatherfuckers to pay for your treatment.

[saracat]

88. You know,I have really got to laugh at this! Scream as loud as I can? if I could , I wouldn't need

to:rofl: The ratfuckers have no shame but I am going to try to negotiate first. I know I have the doctor on my side and he is one of the top 100 Docs.in America.So I am not friendless in this.

[femrap]

89. Good....I

know some people have gotten decisions reversed by getting the 'health care' companies publicly portrayed as greedy murderers.

[AtheistCrusader]

87. Lawyer up. It's the only language these leeches speak.

Find the biggest asshole lawyer you can, let him or her stick it to them.

As the other posters mentioned, the Media is your friend too.

[LSK]

95. try getting a hold of Senator Sanders

He seems like someone pretty accessible to people and he would definitely be sympathetic to your situation.

http://sanders.senate.gov/

[asdjrocky]

97. Sorry saracat. Hope it works out.

[kudzu22]

98. Did they say why?

They have to give a reason for denying a claim, even if it's a BS reason. Medical necessity, experimental, botox exclusion, something. Find out the reason and then challenge it. If they literally gave no reason, then file a complaint with your state insurance commissioner. That always gets their attention. You can also have your claim reviewed by an outside firm.

Most importantly, don't give up!

[David Zephyr]

101. Number 146. Blue Cross is the great Double Cross.

saracat, I have two friends who have been dropped or "reduced down" since August of last year.

Why in the hell can't the teabaggers see who their enemy is?

We are all in this same lousy, leaky and sinking boat now. I am still in my 50's and my rates are so high now that I have no recourse but to take the higher premiums they serve up every six months like clockwork now.

I am so sorry to ready about you going through this. I have come to admire you all these years and count on your voice here.

This is so wrong!

[PatrynXX]

103. BC/BS is Blue Cross? Bullshit

or Wellmark in Iowa except it's not. but they say it is. they won't cover my mental health problems. have the state to thank for that but if I leave the state might not have anyone to turn to. Wisconsin has one and Iowa has one. not sure about other states.

$20 copay. heck even when I first got my shots for testosterone the nurses said no way would you pay a copay for that. sure enough $15 shot if I didn't have insurance , but with insurance still have to pay $20 in copay. Sounds like fraud to me. $5 goes where? o-O

Welcome to Wellfuck by Blue Cross Bullshit :P

[PatrynXX]

104. actually in addition

went in one dad and they had the H1N1 shots available. So I got a $40 bill instead. Yep a copay for each fucking shot.

[Blue_Tires]

105. so much for the "greatest healthcare in the world"

:grr:

[earth mom]

106. So sorry to hear this! What they are doing to you is criminal.

:grouphug:

[gleaner]

109. I'm very sorry this is happening to you....

There has got to be a solution. Does Arizona have a State Department of Insurance which has the authority to accept complaints from consumers when their insurance companies act in bad faith? In California we do, and they take the position that if an insurance company, health or otherwise, writes business in California they must adhere to California law. If Arizona has something like that you can complain to them that Blue Shield violated a past practice without warning. That would get the last treatment paid for at least.

If you don't have a Dept of Insurance that will do that, ask the doctor who administers the Botox to help you write an appeal. When my husband was in the hospital in 2008 and his insurance company was refusing to pay for necessary treatments or even room and board, the head Caseworker in the hospital wrote the appeals and won all of them. His Hematologist wrote a letter regarding an expensive medicine he needed as an outpatient and managed to jar it out of the insurance company which was refusing to pay for it. Your doctors can be very helpful with appeals. With the health insurance companies acting as they are, they write a lot of them. Even if you don't think it will do any good, please appeal. It can be important if you want to take further action later.

Try an attorney. Look for one who will give you a free consultation. There are a lot of them who will, and they will take a case with a fee arrangement. I have MS and the MS society provides help and referrals whenever they can. Even though your medical condition is very rare, see if you can find a foundation or helping group. They can often give you referrals, valuable advice and help you through situations like this. Again, they would look for resources which would take into consideration your ability to pay.

A lawyer might very well be interested in your situation because Blue Cross is violating a past practice. A case can be made that they are obliged to continue a past practice unless they give you ample warning that they are going to stop and give you a chance to appeal at that point, before you need your next treatment.

Also, publicity right now is valuable. You have a background in that area, and if you can find a friend or colleague to help you pinpoint it to your health and Blue Cross most people would be outraged at what they are doing to you. I am. It could be any of us. It could be anytime and it could be many prescriptions and treatments that we take for granted.

In any event, you have my deepest sympathy and a great deal of empathy. I do so hope this can be turned around, and I am very upset that this is happening to you in the first place. If there is anything I can do for you, please PM me. I would try my best to help.