What can you do if your health insurance denies payment for a much needed surgery?
My husband is in desperate need of disc surgery and is at a point that he can not walk nor sit. He was going to have 360 spinal fusion but his insurance bc bs denied the surgery. It's already been threw 4 appeals. His new MRI's showed further damage within 1 month from the last. Do we have a legal stand against our insurance or what can we do. This is a very urgent surgery that needs to be done asap. Please help. Thank You !! Emily
I live in the UK such treatments are coverd under our countries health care program, we contribute all our working life and pay nil for medical care. It is a shame that opposistion in America has almost brought to a halt such a fair medical care system for all, including yourselves. To to an charity that was linked to your husbands past work, they sometimes have funds that help, or past union membership.
Do not allow any tension to set in at all on your part.Health is not something that anyone can dilly-dally about.Anything pertaining to health issue must be focussed on first and be urgently attended to before ever putting other things into consideration as first thing,they say first.Do endeavour to make some phone calls to as many family friends as you can and don't you ever prejudge that 'this or that' person may perhaps not have the money or be of help.Help will surely manifest...!.
Having worked in insurance, and in one of the BCBS in the past, it sounds like their Medical Policy/Utilization unit is really making this decision. I would recommend that you build a very strong case against them, not through your appeals, but through letters and requests from your physicians. Make the medical case really strong as to why he needs the surgery. If he can not walk or sit then he's not working? So show how the lack of surgery is a detriment to your quality of life. Again, if you can get the doctors to make the case for you then it's stronger. Also, consider, how did the injury happen? if it happened at work, then it should be covered under worker's compensation right? Might be time to get a free consultation from a local lawyer as to what your next steps could be.
My guess is that your BCBS insurance will make him go through the cheapest path first, i.e. doctor visits and physical therapy, until that is exhausted they may never cover the surgery. Hope this helps.
you just found out one of the drawbacks of living in a country where healthcare isn't free for everyone. this is one of the reasons i always shake my head when americans go against having healthcare for everyone.
The health insurance lobbyist has got most of politicians, especially the Republican on their side.
The US health care system has profit as it highest priority and not the health of the masses.
I too have work for these health insurance corporations and I know many of these executives are aware of the sufferings and deaths they have caused by cutting cost to increase their profit margins.
Until we remove these parasitic business based health care system I don't see any relief for the masses.
I would suggest traveling overseas for surgery. It will cost much less.
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