Scary spinal cyst only the beginning

I spoke to my friend, Richard, today a couple of months after he underwent surgery to dissolve a spinal cyst. He had suffered quite a bit prior to the diagnosis - leg and back pain, weakness, and exhaustion. Richard's a gym rat and attended weekly cycling classes, so naturally, he was pretty distressed about the whole business.

He checked into a local hospital, the surgery was performed, he stayed overnight and had been doing quite well. Until he went to his mailbox. There was a bill from Blue Cross/Blue Shield. They paid for the operating room and the CAT-scan which guided the doctors, but they denied the procedure!!! The insurance rep said "epidural injections were not medically necessary." So Richard, along with his surgeon's office are fighting the $1,700 charge.

But we don't want any government bureaucrat interfering with our health care, do we?

What was he supposed to do? Down a pint of whisky and bite down on a stick?

Would they have covered the BevMo run and the stick? I fear we are living in the dark ages. This is just nuts.

The injections were what actually dissolved the cyst! The billing person told my friend he requested to the insurance rep that until this is appealed amd resolved NOT to report him to a collection agency for non-payment.

Unbelievable.:grr:

Got out of bed and the pain was so intense I fell down and had to be moved to the hospital in a stretcher - I thought I was paralyzed.

Operating on the cyst was relatively simple but it was intensely painful.

I think my friend Richard was in more pain than he let on now that I hear this from you. Hope neither of you ever have to go through this again.

The guy always thought he had great insurance. Of course, he got hit up for a $700 co-pay the morning he arrived at the hospital. He said he hadn't thought to bring his checkbook with him, but put it on a credit card.

He was pre-approved for the procedure, but now insurance company is saying the procedure wasn't medically necessary.

Not only is Richard an attorney himself - he's a judge for SSA. He'll fight hard and I believe he'll win. Stay tuned.

Not only is Richard an attorney himself - he's a judge for SSA. He'll fight hard and I believe he'll win. Stay tuned.

Ai-yi-yi. :banghead:

Hekate

$1,700 on the backs of every one of their customers who undergo surgery over a year adds up to a hefty profit.

to deny claims and make people fight for the benefits they have coming. People who don't know any better or are too sick to fight end up paying the bill themselves. It's just one more way the insurance companies maximize profits on the backs of patients.

there is no good reason why this kind of breech of contract isn't punishable with huge fines and jail time. the whole reason we have governing bodies is to protect the powerless from those who kill for profit.

explain the procedure. I have a family member who is an anesthesiologist, and her billing gets all screwed up in ways you wouldn't even believe just because one coding number is off by a tenth.

OTOH, if that's been attempted and they still deny it, that's just insane. I would fight it - demand to take it up the ladder. On a matter of principle, I fought my insurance company and the lab that provided services for me for two years over a $250 bill. I finally won, without being taken to collections, etc.

of my cyberspace friends with Richard. Thank you, all.

:grouphug: