My medical condition isn’t supposed to be causing me pain, but it is, so does that make me a special snowflake SJ community? Does that mean I am one of you? Does this deem me worthy to have my case viewed by your community as valid?
From first hand experience, the insurance company doesn’t care if you’re white, black, or hispanic. If you’re relying on them to pay for your medical costs THEY dictate whether they want to pay or not. It’s not about color, race, or personal matters. You can be lying on your death bed and if the procedure that’s going to save your life is deemed experimental, they will let you DIE because they will not pay for it.
So far the United Health Care has denied my procedure to do a bland embolization on the growths in my liver which are causing me pain, I had done this procedure a year previous and it got rid of the growths without any symptoms and for once I felt normal and healthy. Now the pain has started back in february so we had scheduled the procedure to be the first week in March to get rid of the 4 new growths in my liver.
A few days before surgery I received a letter from the insurance company saying my procedure was denied and it wasn’t covered under my mother’s insurance plan deeming it was ‘an experimental procedure’. They sent a letter stating the appeals process, the initial doctor said ‘no, it’s experimental’, well then we waited for the word from the Interventional Radiologist (peer review) to say about the procedure. We were supposed to hear word from them April 27th, well that’s when we stopped hearing form the insurance company and no one was giving us answers.
This was when we seeked help from the Insurance commissioner to have the company release the information, United Health Care had up until the end of the month, 2 business weeks to give us the information on what the Radiologist said or they’d be fined and in big trouble. At this point we thought the radiologist had approved my surgery hence why they had not given us the information.
Lo and behold middle of May my mother who was at her wits end, after going to the hospital three times with me because of my level of pain and countless specialists who couldn’t figure out what was wrong besides me liver. She called United Health Care for the status of the appeal, they had informed her it was ended.
Long story short, they had come up with some form I had not filled out to proceed with the second appeal. Well, the next day we were informed that they Interventional Radiologist has reached his conclusion and pronounced the bland embolization ‘experimental’.
The doctor’s office then referred me to a surgeon, since the insurance company had said ‘we’ll pay for surgery, just not the procedure’.
Fun facts I learned:
- The bland embolization is cheaper than the surgery
- The surgeon informed us from the locations of the tumors he cannot get to them via laparoscopy or with general surgery without causing major damage or, death.
- Previous internal liver scar tissue plus the pain from the current tumors is probably why I’m in so much pain, so doing surgery would make it worse.
- The locations of the tumors are in dangerous spots as well to get to surgically, through the bland embolization it’d be perfectly safe because it’s internal and relies on the veins to maneuver to get to the growths they’re feeding, cut off the supply and the growths die off and disappear as proven by the first procedure I had done a year previous.
So now the surgeon I saw today wants to fight the insurance company because the bland embolization is my only option. He’s a liver surgeon and he’s not comfortable doing the surgery that United healthcare covers. So now the surgeon and my doctor are going to fight till the tooth and nail for this to get appealed again.
What if, that isn’t enough? What if the insurance company still deems this procedure an experiment they’re not willing to pay for? Am I to live out the rest of my life on Percocet in and out of pain management? A 20 year old girl should not have to live off Percocet to get through her day, and not even Percocet is helping at this point.
So what I’m going to do now is fight. I’m going to fight to have my case heard. NPR, NBC Nightly News, I don’t care.
I’m tired of being swept under the rug. I’m tired of having to live this way, this is no way to live. In pain every day, hospital ERs not caring and specialists suggesting pain management because they don’t even know what wrong with you and you know more about your condition than THEY do.
I don’t want comments of ‘I’m sorry I understand’ or ‘I hope they figure out a way and help you!’, no I want people who will promise me to stand by my side and help me fight this. I want people to write letters like I will to NPR, MSNBC, news networks, medical sites, insurance sites, ANYTHING, EVERYWHERE.
I don’t want REBLOG IF YOU CARE. I want REBLOG TO SPREAD THE WORD. I want people to join me and fight the insurance company to get my case known and helped, and I want others to get their cases known as well.
So REBLOG TO SPREAD THE WORD AND GET THIS CASE KNOWN.
Sincerely,
-Courtney Rose
