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How Bad Can an Insurance Battle Get?
from Kathleen S.

(July 24, 2003)

Ed:  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?

Thanks, -Just sign me another Keystone Health Central victim.


(August 25, 2003)

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.

Since my 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 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.


Ed’s Response:  I just tried Yahoo, which pointed me to this site:

Sounds like 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.

Reading what 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.

Now, in addition to breaking news from the insurance battlefield, please keep us apprized of what Remicade does for you.  -Ed

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