Rumigirl
Frequent Contributor (1K+ posts)
Member # 15091
posted
[I see the thread that Razzle has about this and will check out those ideas, some of which I've tried in the past].
My insurance is completely refusing to cover the 2 compounded meds that were helping me with the severe nerve pain condition that I've had for 2 years now: Complex Regional Pain Syndrome, aka, Reflex Sympathetic Dystrophy. This is in spite of the fact that they already gave me Prior Authorizations for them.
They won't answer my calls, calls for PA's from my doctor's, from the pharmacist, online complaints, etc!! They are determined to cover NO compounded meds, no matter what.
As it is, they deny many of my meds for the infections, too, and for anything else, regardless of letters of Medical Necessity, Appeals, etc., etc.
Actually, they are trying to cover nothing for me now, not doctor visits, therapy, meds, anything! They have a million ways to pretend they receive nothing, 4 times in a row, faxed to specific supervisors, etc. (Sorry for the rant!)
Ironically, I know very well how to fight these denials;.I've been doing it for years. I fight harder than anyone i know, and have had many things covered before..
However, they are stone-walling me completely now. And I am in worse shape than ever.
I just can't take it anymore. I am not sleeping much, my heart rate has been extremely high 24/7 for about a year now, due to the constant, severe pain. (I should be doing something about the heart rate).
I desperately need an Advocate or insurance person, as Razzle recently posted, too. I've never found one, in spite of trying for years.
I'm wiling to pay someone to help me, but even so have drawn a blank repeatedly. Need to try again. Thank you! I/we need a fairy godmother! Posts: 3771 | From around | Registered: Mar 2008
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posted
It breaks my heart that you can't get the help you need. I know sammy went through this for a long time. Keep fighting, Rumigirl! Please don't give up!
-------------------- --Lymetutu-- Opinions, not medical advice! Posts: 96222 | From Texas | Registered: Feb 2001
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posted
If this is your reality, could you just thumb your nose at the whole abx thing and treat yourself with herbs?
Posts: 653 | From Northern Virginia | Registered: Oct 2014
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Rumigirl
Frequent Contributor (1K+ posts)
Member # 15091
posted
Thank you, Lymetoo and tulips!!! (I owe sammy a call).
I need to figure out where to go from here re treatment. But first I'm trying to get some pain control that I can tolerate, so I can go on at all!! No, I'm not giving up, but it is horribly hard to keep going, when I am up all night in terrible pain.
I did complain again to the state Attorney General's office about Aetna refusing to respond at all. Even that office was not getting back to me, but now I finally got a VM that they are addressing it with Aetna.
But today in the mail I got a response to a complaint that they won't cover the meds when I already have Prior Authorizations. BUT, Aetna pretended they had no idea what the med was (I had all the details in the complaint).
They said, you can appeal it. But I can't, because they refuse to put their denials in writing. Plus, they sent me forms for the appeals from a state across the country from where I am??!! WTH?? It all seems quite deliberate----or unreal incompetence, too.
To be continued . . . I'm so fed up with these corporations that just push us over the edge and hope that we drop off the face of the earth, so they don't ever have to pay for us again.
[ 03-25-2016, 10:05 PM: Message edited by: Rumigirl ]
Posts: 3771 | From around | Registered: Mar 2008
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Phoiph
Frequent Contributor (1K+ posts)
Member # 41238
posted
Rumigirl...
I know of a patient advocate that is reasonably priced and has a good track record for effectiveness.
You can PM me for her contact info if you like.
Posts: 1885 | From Earth | Registered: Jul 2013
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posted
Call the Lyme Disease United Coalition at (800) 311-7518. They are very knowledgeable and also have good information for different resources on their website:
-------------------- --Lymetutu-- Opinions, not medical advice! Posts: 96222 | From Texas | Registered: Feb 2001
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Rumigirl
Frequent Contributor (1K+ posts)
Member # 15091
posted
quote:Originally posted by Phoiph: Rumigirl...
I know of a patient advocate that is reasonably priced and has a good track record for effectiveness.
You can PM me for her contact info if you like.
Yes, I will, thank you, Phoiph. (I tried responding 5 days ago or so, but LN was kaput).
BTW, "funnily" enough, I was afraid when I was posting that you would gently chide me for not trying the mHBOT, but in your compassion, you didn't.
It's not that am uninterested in it; it's that it's overwhelming to me at this point to do it (no space, no money, other priorities, etc.). Thank you.
Posts: 3771 | From around | Registered: Mar 2008
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Rumigirl
Frequent Contributor (1K+ posts)
Member # 15091
Thank you, Lymetoo. I've heard of it, and checked it out after you posted this. It sounds great! BTW, as above, I responded many days ago, but that was when LN was kaput, so it didn't "take."
Posts: 3771 | From around | Registered: Mar 2008
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Rumigirl
Frequent Contributor (1K+ posts)
Member # 15091
posted
quote:Originally posted by hopingandpraying: Call the Lyme Disease United Coalition at (800) 311-7518. They are very knowledgeable and also have good information for different resources on their website:
Maybe they could help you or refer you to someone.
Wow, thank you hoping!! I will check that out.
I am so glad that LN is finally working again. I tried for 4 days to respond to everyone, but no dice.
Posts: 3771 | From around | Registered: Mar 2008
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Phoiph
Frequent Contributor (1K+ posts)
Member # 41238
posted
Rumigirl...
I just PM'd you the advocate's contact information.
No worries about mHBOT...I totally understand...it is a big commitment. I feel my responsibility is to get the information out there...what people do with it is totally up to them...no judgment involved!
Posts: 1885 | From Earth | Registered: Jul 2013
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