Insurance denial for secondary surgery

[Jack's mom]

Hi. I'm Robin. I'm from N.O. and found out about the surgery at TCH @ 2 years ago. My son Jack has OBPI and is 9 years old. No doctor here has been able to do anything for him (besides therapy, they didn't even know about a secondary mod quad surgery).

I finally got Jack over there where we found out that the surgery will benefit and now my insurance is denying benefits saying that it is experimental!!!! Can anyone give me a direction???

[admin]

By the way, the insurance company is Coventry Health Care and if anyone has had them pay a claim for you I would be forever grateful if you could fill me in.

[Tessie258]

I would contact the doctor and have them write letters for you explaining that the surgery isn't exoerimental!!! My son had the mod quad at age 10 and it did help.....It's not a 100 % cure but it really did give him more movement.
Good luck and keep fighting, don't give up!!!
T.

[Francine_Litz]

Jack's mom - yes get the doc to write a very strong letter - get the pediatrician to write a strong letter - find out how the appeal process works - contact your local representative - ask TCH if anyone else has ever used that insurance - it'll take to get all this together - you gotta start right away...

just hammer them to death until they cave....
experimental...yearightsure

-francine

[admin]

Robin,

Fight, fight, fight! Get all the info. and letters that you can.

I have heard insurance companies using the experimental excuse before which is especially frustrating. This is just one reason why research and studying actual surgical outcomes is so crucial. If not to better future treatment for our children, to help us deal with insurance companies who can get away with saying it is "experimental". They can say it because there isn't much published data. So glad that some doctors are working hard to gather and publish such data. The last thing I need is to fight for my child's surgery when I feel like I have to fight for everything else.

Good luck. I hope things work out for you and your son.

[admin]

bumping up

[admin]

Thank you for your response. Can't tell you how much your support helps. My son will have his surgury no matter what. I am so very hopefully optimistic and so is he. I am so grateful to all of the doctors for their research and development and all of you parents for your messages in how well the surgery works.

[admin]

Just wanted to thank you all for your support! We just found out today after lots of calls and contacts with so many people, including state commissioner, CEO's etc, with insurance, our group sales rep, George, Lisa, local pediatrician, local neurologist and orthopedist and everybody I could find that had some connection with somebody in these fields. Any many many prayers! Jack is having is surgery November 18 covered by insurance. We are so excited!
Prayers to you all, Robin

[Francine_Litz]

It's just HORRIBLE that so many people have to get involved and I'm sure that it became a full time job for you as it did for me. We need to fight and to let people (insurance companies and government representatives, etc.) know that this is truly unacceptible.

I'm so glad you got it finally approved but I hope you write to everyone you had to fight with to tell them that it is absolutely unacceptible.

good luck in November - we'll keep you guys in our thoughts and prayers,
francine