So far, so bad...the continuing insurance saga...

[Katie]

Hey, I had them there ESIs!! And they didn't do a darn thing for me after the first one or two...and those barely made an impression. Thanks for the explanation Justin...once again.

As for reimbursement for pain, suffering and damages, has anyone ever collected for that...ever? Guess that would be asking for miracles...

As for the rest.....

(Except for the possible get together, of course !!)

[KBear]

As for reimbursement for pain, suffering and damages, has anyone ever collected for that...ever? Guess that would be asking for miracles...

People have collected lots here for pain, suffering and damages. I know that you can not get as much as used to be able to, new laws (I believe they are called tort reform laws). It also depends on where you live, like I live in a very conservative county, which means, if I go to trial, I will get way less than someone who lives in a liberal county.

[Katie]

Does that apply to patients like us as well, spine patients who have been on the wrong side of the system, either by stalling or ???

[Nairek]

Katie,

I've been out of the loop here for a bit. My brain is fried from the upcoming move out of state that I am totally unprepared for.

I can't go too in depth here with a reply. I'm dealing with the percocet fuzz at the moment

Insurance companies, for the lack of a better word, SUCK! They will do everything that they can to discourage you so that you give up. Their only concern is to make money & to heck with the client. I speak from experience on this. I went up against BCBS & MVP Healthcare. Even took my BCBS case to the NYS Insurance Dept. & still lost. Both my attorney & my OS thought I would win with my appeal package & were shocked when I was denied.

Dr. Bitan went to bat for me with MVP. He even called them & spoke to the medical director personally. Even after all of that, MVP still declined ADR & forced me into a fusion. I was PO'd!

I'll be in touch with you & hopefully will have a better response to your post. In the meantime, keep fighting girl! Don't let them win!

Karin

[Katie]

I appreciate your support...I really do. I just hired a lawyer and am wondering if I made a mistake.

What can they do that I can't? I feel like I might be wasting my money...that I don't have to waste. It isn't that the lawyer isn't good, or that I don't like her...I just don't know what she will be able to help me with.

The Appeal board once said that my submission for going to Germany was as good or better than any they had seen done by a lawyer...and it was all my own work. I postponed that one before the hearing because of pneumonia and the hope that Dr. Bitan's letter would get me treatment sooner. (Even after having a hearing, the ruling can take up to six months for an answer)

I really didn't think the insurance would make me submit another application. Didn't think...the key words, I guess.

If Dr. Bitan went that far for you, perhaps he may go to bat for me as well. I know he has a strong dislike for the insurance companies, and Canadian government ones as well. I think that he is out of the country for a few weeks right now, though. I'll check with his office tomorrow. His opinion will carry a great deal of weight, according to the lawyer. I hope she's right.

Off to bed, and hope for the best tomorrow. Thanks again. I'd like to hear more of your story.

[KBear]

Katie, The to have a lawyer or not is a tough question. I can see both sides of the argument. One side being, you can do it yourself and possibly get approval without them and save money. The other being, that the lawyer knows the law better, has experience in this and also lets the other side know you are serious. I had originally not hired an attorney when I was in my first accident, as I naively assumed the other party would be fair and do that right thing. After trying to deal with them myself and it becoming clear that they had no intention of doing the right thing, I hired an attorney. Even with my attorney, they tried to 'screw' me; they offered me less money than my medical bills. They made me go through through the whole deposition and file to go to trial. They even tried to imply that the wreck was my fault (even though the police investigation said it was clearly the other drivers fault, the other driver was ticketed for 'failure to maintain lane' and I had pictures of the accident with the other guys truck in my lane.) Then, when I was in the 2nd wreck, the complication of the law (this is called an 'intervening action' and thus made that driver responsible for me from that point on), made it where I needed an attorney. Basically, this made it where the first wreck could say my injuries were from the 2nd and the 2nd wreck could say they were from the first. Here in the states, you generally get more money if you have an attorney (but the attorney gets 30-40% of that; so in the end you probably end up with the same as if you didn't have one). I have heard of people getting really cheated if that didn't have one and went up against them by themselves. Really puts you between a rock and a hard spot. Good Luck in your decision.

[Justin]

Katie, I completely understand about doing more work than your lawyer (and most of it much, much better ).

I think a lawyer is a formality in your case. They really don't do much more than you've done, but it does help in the game of "law" to have one represent you.

Good luck and realize you are doing the right thing--I know it's very difficult not to second guess yourself.

[Katie]

Wow, you have been through so much. All that on top of spine problems. I don't know how you kept going. I sure don't feel like going on today....feel like I'm just floundering.

I sent an email to Dr. Bitan, asking for his help, as the lawyer said that it would help if he made it very plain how urgent this is...how much I am at risk right now. His assistant called this morning to say that they had a surgery date booked for me, and what was I up to. Was I coming down soon...I had to explain the mess I'm in and told him about the email to Dr. Bitan. He is going to look into it and get back to me, as Dr. B was in surgery.

Apparently Dr. B is only going to be out of the office for a few days, not two weeks as he originally planned. So that's a good thing. But my PM doctor who the insurance wants to use to refer me to Ontario doctors is still out of the province. She hasn't answered my emails, so I don't know when this process will get back on the tracks.

We're going into the third week now, with no progress since I sent in the new application. I doubt I'll be in for a consult with a new surgeon here till July or August, and that's just a consult, not surgery. The only hope I have is that it will take so long that my lawyer can argue the process is taking too long, and push me to see Dr. Bitan. Fingers crossed. So maybe that's what the lawyer will be good for.

[KBear]

I had my days, where I felt totally defeated, hopeless and out of energy; where I just wanted to quit. During the last 3 years, I contemplated suicide, no telling how many times. I literally had myself convinced that my family would be better off without me (I felt like such a liability, taking tons of money for my medical and not being able to pull my own weight) It was a very dark and lonely place to be. Finding these boards really helped me deal with all the emotional parts of this. It is hard being in pain, then having to fight for what is fair on top of that. I am so glad that I have the surgery, am feeling better and in a way better place emotionally. Have your sad day, as I call them, then wake up tomorrow ready to fight again, that's all you can do. You will get through this, although I know it seems like it will never end, it will.

[Katie]

Justin, so I do need her, but just to make things appear right, and cover all the bases? To have her verify my actions to the insurance board? It seems like a lot to pay just for that. You never know, maybe I am missing something in the process that she can point out. I sure hope so...I could pay a lot of bills with that money!

KBear, today is just one of those days...you pegged it. I was resigned to the fact that I have to start my battle all over again, and thought I would have to wait till Dr. Bitan came back to give me some supporting documents, then we would start battling in a few weeks. So I was just coasting and ignoring the overwhelming facts.

What tipped me over the edge was having his assistant call this morning and saying that they had a surgery date for me if I was ready. Just that carrot dangling in front of me has set me off.

And yes, I'll be OK tomorrow. In the meantime I'm working on a painting commission due on Friday, and gazing at my garden, planning on where which plants will go where. And forgetting about that surgery date....for now.

Thanks for the help. It means a lot, especially on bad days.