| Author | Message | ||
| Dr Tommy Cosgrove (Vwalfa4re)
Member Username: Vwalfa4re Post Number: 874 Registered: 5-2001 |
Martin - I had a similar experience. Back in 93 I was hit by someone in my 80 Scirocco. I can't begin to go into the modifications/restoration this car has had. Bare metal paint, new leather, everything. The left rear 1/4 panel was smashed but the car ran fine and there was no damage to the suspension. Some a$$hole from their ins co. told me one night on the phone that the repair exceeded the car's value and all they were going to do was cut me a check for, like, $800. I had a great car. What am I going to buy for $800? I told the guy to go F-ck himself (exact quote)and he would hear from my attorney. My mother was married to an attorney at the time. He was a real mean SOB too. Anyway I had him call the guy that night. The next day I learned they were going to fix my car. I got hold of a fax from that guy on the phone and it had a time and date that told me that he faxed an approval to his company right after he spoke to my (then) stepdad. Same story, try to intimidate the weak. He wasn't scared of me or my stepdad. He just knew his fat butt was about to get drug into court and would have to answer to a judge or whatever. I got only what was comming to me and they tried to withhold it thinking I would roll over. | ||
| Martin - Cavallino Motors (Miami348ts)
Advanced Member Username: Miami348ts Post Number: 4077 Registered: 5-2001 |
Dr. Tommy you should document that as well and send it to the insurance commissioner. You may not be allowed to but I would anyway. | ||
| Martin - Cavallino Motors (Miami348ts)
Advanced Member Username: Miami348ts Post Number: 4076 Registered: 5-2001 |
As long as insurance companies are run for profit you will have to deal with "cutting cost" down. The less they pay, the more they make. I had a case where someboy ran into my Jeep. The other insurance co wanted top put me into a Midsize rental. I said no way, I will take a Jeep or equivalent SUV. They said I would have to pay the difference to the Midsize, I said, we"ll see about that in court then I guess. They did pay for the Jeep and later I found out that they do that with everybody. Unless you stand up and threaten suit they will not pay for what you are due. An insurance expert told me that only 25% of the people will stand up, which means that 3 out of 4 will eat it and they save Millions that way. Insurance Cos suck! Stand up and fight them. Unfortunately when you have cancer you have all kinds of other things on your mind. Fighting the Insurance will not help your cancer in the first place. | ||
| Dr Tommy Cosgrove (Vwalfa4re)
Member Username: Vwalfa4re Post Number: 866 Registered: 5-2001 |
Both my patient and I followed the rules according to HER contract that she and the insurance company agreed to. Patients are not entitled to benefits that are specifically excluded but they are entitled to benefits that are specifically INCLUDED. They BROKE those rules and they LIED about it. I see this happen on at least a weekly basis in my practice. I guess anyone can call it whatever they want, health benefits, rich uncle, whatever. They are still legally obligated to play by the rules that THEY MAKE when the patient signs their contract and gives them money. Period. Anything less is fraud and is illegal. | ||
| ken rentiers (Rentiers)
Junior Member Username: Rentiers Post Number: 188 Registered: 2-2003 |
Nebulizer class is right! Nazis aren't capitalists. Also "coporate" would be literally a turd, as in coprophagia which means ••••-eating in latin, but I think you wanted "corporate" which means body - a corporation is a legal person. Anyway - the problem is prepaid healthcare per se. When you remove the burden of payment from the consumer unlimited demand is created. This leads to Orwellian situations like the one above, as the insurer attempts to control costs. It also leads to soaring premiums. This is NOT insurance, insurance would be payment for unforseen major events such as extended hospitalization. The average person costs about $6,000 a year to insure. If you gave the individual $3,000 to be used for medical visits and a $3,000 deductible policy, the costs of health care would begin to become rational again. You want a car, your policy says you can have any car, you pick a Ferrari. You want a car, you have to pay for it with your own money.... At present no marketplace exists in medical care. | ||
| Dr Tommy Cosgrove (Vwalfa4re)
Member Username: Vwalfa4re Post Number: 861 Registered: 5-2001 |
I think he means the popular definition of Nazi: scumbag bastards. | ||
| Nebula Class (Nebulaclass)
Member Username: Nebulaclass Post Number: 296 Registered: 11-2002 |
DES - Nazi's aren't capitalists. Just thought I'd let you know. | ||
| Tyler (Bahiaau)
Member Username: Bahiaau Post Number: 634 Registered: 12-2001 |
DES, I agree, they are bastards. Dr. Tommy. they CERTAINLY lie. I work in the medical industry, have several friends who are surgeons and I have witnessed first hand people who's lives have been affected by insurance companys balking at treatment. Many people blame the Docs, but their hands are often tied by the patients insurance. | ||
| Dr Tommy Cosgrove (Vwalfa4re)
Member Username: Vwalfa4re Post Number: 857 Registered: 5-2001 |
I deal with insurance companies on behalf of my patients daily. I have been LIED to more times then I can count. I want to be very clear about what I just stated: LIED TO. For example: Last Friday I get a denial letter for a procedure I did on a patient a few weeks earlier. The letter stated very clearly the procedure (a crown) was denied because it had been less the five years since it was first placed. Problem - The claim we mailed with an x-ray stated the crown was placed in 1981. I called them and they told me it was actually denied because I didn't mail an x-ray. I thought that was a strange thing to tell me because THEY MAILED MY X-RAY BACK TO ME TWO DAYS EARLIER!! I deal with these lies every single day. This is just one example. I have about 345,918,945 more if anyone is interested. DES - if you want to yank a knot in that insurance company there is only one way to do it and this works every time. Have your client write a letter of complaint to that state's insurance commissioner. The letter has to be from the patient and signed by the patient. This is the only thing that can hurt the ins co. They do not want complaints on record against them with the state. The only time this will not work is if your client is insured thru a TPA. Give it a try. | ||
| Jon P. Kofod (95f355c)
Member Username: 95f355c Post Number: 529 Registered: 8-2001 |
DES, I am no doctor, but my mom died of lung cancer four years ago yesterday (March 20th 99'). I don't think the PET scan was available then, as I can't remember ever hearing the terms used back then. I can tell you from hundreds of hours of studying lung cancer back in 99' that this form of cancer is nearly impossible to detect early. Cancer is broken down to three stages and only in Stage 1 can surgery be done. Most of the time lung cancer will not show up on x-rays, cat scans or MRI's until it's stage 2 or stage 3 cancer, neither of which has a high success rate. Most of the time lung cancer is discovered in the middle of Stage 2 or beginning of Stage 3. At this point many scans (MRI, X-Ray, CAT etc.) are only used to confirm how far the cancer has spread and to what areas. I seem to recall that Stage 2 lung cancer had a 12-15% survival rate and Stage 3 was about 3-5% assuming treatment was undertaken. It may be that the PET scan is very costly and that your patient may be classified as Stage 3, which is usually terminal. The insurance companies should still pay for it but many don't. I hope everything works out for your client. Please advise him of http://www.alcase.org/ it's a great website for lung cancer patients and survivors. There is a lot of support info and other valuable resources. I used the site and organization while my mother was being treated for cancer and have since become a volunteer with them. I seem to recall you are from NY so tell him to go to Sloan Kettering in NYC if he has a choice. They treated my mother and although she eventually lost the battle with cancer, the folks at Sloan Kettering were extremely helpful and caring. Regards, Jon P. Kofod 1995 F355 Challenge #23 | ||
| DES (Sickspeed)
Advanced Member Username: Sickspeed Post Number: 2924 Registered: 8-2002 |
Sorry, "The Don", won't happen again...  i used to enjoy this job, 'cause at the end of the day i could go home knowing i made someone else's day easier or helped someone achieve or acquire some type of medical something and that they'd be better off... But it seems lately, with NYs new HIPAA laws, that making things easier for others is getting harder and harder for us... This guy's at home with lung cancer and i have to call him and tell him that he's got to appeal to the state- and that he needs to send a $50 check with his application for his appeal to process... This is such ridiculous bullshit, it's disgusting... Some days i wonder why i even get up... | ||
| "The Don" (Mlemus)
Advanced Member Username: Mlemus Post Number: 3249 Registered: 8-2002 |
Dan, It's "the don" to you.... I agree. They are making money on people dying. Very sad. Matt | ||
| DES (Sickspeed)
Advanced Member Username: Sickspeed Post Number: 2923 Registered: 8-2002 |
It's not for me, Don, it's for a client... i'm all over the phone right now, but it's ridiculous that lung cancer doesn't meet the protocol for a friggin' PET scan... Like- what are people supposed to do...? Is this seriously the way of the world...? We just accept this bullshit...? | ||
| "The Don" (Mlemus)
Advanced Member Username: Mlemus Post Number: 3248 Registered: 8-2002 |
I had no problems with Healtnet and my petscan in Sept 02. Have your benifits office call the healthcare rep. | ||
| DES (Sickspeed)
Advanced Member Username: Sickspeed Post Number: 2922 Registered: 8-2002 |
According to a certain medical pre-certification company over here, lung cancer does not meet the protocol for a PET scan...! This is ridiculous...! i have to call someone and tell him he can't get his PET scan for his lung cancer 'cause his lung cancer doesn't meet protocol... This is such bullshit... |