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Bad Can an Insurance Battle Get?
(July 24, 2003)
I am a 42 year old female with P since my early 20's. Right now my
skin is at about 30% and I psoriatic arthritis. My primary care physician
suspects my chest pains are not stress but possible pericardial
inflammation. My rheumatologist has filled out the necessary form
including a letter of medical necessity. But the director over at my
insurance company who for the moment I shall refer to as Chad S. who has
an Associates Degree in business from the local community college has
denied the request. Ball park dollar amount from the doctor is 3 grand per
treatment times 7 in a year. 21,000 dollars. Which by the way is about my
annual net income after the govt. and that FICA guy take their cut.
At this cost I
will be lucky if I have enough money to buy a pack of chewing gum per
year. Any ideas on how I can get these cheap no good scoundrels to cough
up the dough?
Hi Ed it's
Kathleen S. to fill you in on the latest with my denial of Remicade
treatment by Keystone Central. I wrote my own appeal and had gobs of
documentation (although I wanted more to send) and it was approved at the
first level. Meaning my first treatment is scheduled for September 8th. (I
had gone to a lawyer and he ripped my appeal to shreds paragraph by
paragraph and he wanted $300 to write the second appeal but he was sure
that I would lose and it would go to litigation ... and $600 bucks
retainer and $150 an hour he charges... So much for him.)
Now over one
hurdle and onto the next.
condition has deteriorated so much I went out on short term disability
effective today. Only one problem. I filed in advance with Unum Provident
who is our new STD company Osram Sylvania picked effective January 1.
Since August 13th I have racked up over 5 hours in cell phone time. (You
just can't call from a landline for some reason.) My
doctor has not received the forms nor have I. So I check in with the
doctor's office 9AM sharp tomorrow and if it's not there I will contact
the state insurance commission and senior officials in the company I work
for. And it's long and sordid but very curious. I should refer you to
excite.com and in the search engine type in “Unum Provident” and see
what kind of nasty stuff pops up. Denial of coverage, class action
lawsuits and suicide because seriously ill people become homeless. 60
Minutes did an expose last fall as did Dateline
NBC. I think I will contact those folks too. I may not get any money
and may be up a creek, but I swear by Christ I will pummel those Nazi
murderers into the ground.
Wish me luck Ed
and I will stay in touch. -Kathleen S.
Response: I just tried Yahoo,
which pointed me to this site:
Unum Provident is the Insurance Company from Hell.
How could any company be deaf to what’s going on with Unum
Provident and decide to use it anyway?
I was pleased
to read you won round one with Keystone without
a lawyer and am hoping your luck holds.
you’ve been through makes me amazed by the numbers of people who are
getting approvals to undergo the new biologic therapies.
My insurance paid out over $10,000 to support my six months on
Enbrel with no results.
addition to breaking news from the insurance battlefield, please keep us
apprized of what Remicade does for you.