The @#$%&! Insurance company has Denied my scooter.

They say it's not medically necessary. x(

Now I have to jump through hoops to appeal.

:hug:

:(

I see my pain management doctor this Friday. I have to call to make an appointment with my GP.

...you should have asked for a wheelchair and they'd deny that, then given you the scooter. :)

My dad was a lifelong sufferer with arthiritis.

Took him better than 2 years and countless doctor's visits (and re-visits) for the state to finally approve his disability claim.

Once he managed that, Medicare told him they'd rent him a wheelchair, and they did...for 30+ fucking years! Dad kept telling them wouldn't it be more economical for them to *buy* one rather than renting forever? ($450 one time vs. the $40-50 a month they were billing?) The idiots at Medicare refused! (I guess Jeebus was suddenly gonna appear before him and tell him walk again and he wouldn't need the chair?)

Dad even went to the TN legislature to testify about the waste...he was furious that they would throw (in essence) his money (and other's) away like that. Did absolutely no good...they finally replaced his old worn out chair with a new one (once again a rental) after renting it for some 20 years.

Then the kicker...they *bought* him a $5000+ motorized chair without him even asking! He didn't want it because he couldn't even use it...the side rails were not removable for him to be able to slide in and out of the thing. His knees were locked. The powered chair (a higher end Jazzy) sat in the corner of the bedroom for over 10 years till the day he died and I finally sold it.

I'm going to assume private insurance will be much the same as far as gross intelligence goes.

Good lock and give 'em hell!!!

Bastards. I'm not sure how to fight these things, but I'm sure someone here will guide you. The key is to fight.

x(

That scooter will help me keep working longer. I'm not letting that cheap-ass insurance company determine when I stop working.

My guess is that they deny them on the first pass as a matter of routine. :grr:

And a lot of times that's true -- people give up often enough to make it worth the insurers' while to deny claims on a routine basis. But if you don't give up, often they will cave in at some point because fighting with you becomes too much trouble and expense for them.

So fight the bastards!

:)

Damn those people!

Not medically necessary, my ass!

It's necessary for your LIFE!

Yes, fight!

It makes me sick to hear this...

I'm in your corner, wishing there were something I could do...:grr:

:hug:

:hug:

Deny that anyone needs medical attention. It doesn't matter if you pay into the scam, as long as they have the final say in denying your claim, it makes them as happy as flies on shit.

Although I don't know about your situation, you shouldn't have to jump through hoops. Especially when it is difficult to do so.


I'm so sorry to hear this. Keep fighting ThomCat. Maybe your doctor will help to recommend/demand that IT IS MEDICAL NECESSITY.


Good Luck, ThomCat. I'll send out some positive vibes for you.

They have been awesome so far, and I know they'll help with this appeal. :)

Thank you for any good vibes you can send. :hug:

stupid damn hoops.

x(

x(

I could charge one and pay it off, but I'll be damned if I'll start paying for stuff that insurance should be paying. That just validates their fraud.

if it comes down to that, you KNOW we've got your back and we'll get you the scooter you need even if we need to find one that's "fallen off a truck" Seriously. Don't fret sweetie. We'll make this happen by hook or by crook.

the scooter you need).

My mom's insurance denied her coverage on something that WAS medically necessary, so her doctor, bless his heart, got on the phone to the CEO of the company and gave him what for. He stammered and stuttered something about it being a mistake, and that of COURSE it would be approved right away. And it was.

So fight, Thom. Other people are right; the insurance companies expect people to just lie down in front of them and say, "Yassah, whatever you want", so when someone fights back, they do sit up and notice.

I'll definitely appeal. And they're going to feel my crutches hitting them in the ass. :P

Wish there was something I could do to help.

If nothing else, I'll hold 'em while you beat the crap outta them!

otherwise what am I going to do with all the horribly tacky bumper stickers I bought? :)

:hug:

:P

Make sure we pick a hairy one too... so it'll sting when the stickers get pulled off. :evilgrin:

:hug:

:hug:

this just makes me SICK. How dare they? Those bastards. x(

But, you know, we have the best health care system in the world and there's absolutely no need for reform. :sarcasm:

I'm so sorry you have to deal with this shit.

:hug:

:hi:

I'm sorry anyone has to deal with insurance companies. :(

Their need for profit has corrupted any positive purpose they once served. Now they exist as legalized fraud.

is EXACTLY right. x(

You're also right that nobody should have to deal with it. But it just seems like you've been particularly screwed recently. And you're such a kind soul. It's just maximally unfair.

:hug:

that is really, really shitty of them. i don't know if they'd know medically necessary if it up and bit them in the ass

i know you'll fight this and we'll be behind you every step of the way

:hug:

:hi:

I really appreciate that. :hug:

http://www.visi.com/juan/congress/cgi-bin/newseek.cgi?site=ctc&state=ny

http://www.cmap.nypirg.org/netmaps/MyGovernment/NYC/MyGovernmentNYC

Wish I had more to offer :hug: :hug: :hug:

:)

My congress-critter is a repuke, so even though I'll write to him I won't expect any kind of a response.

...raise some hell with them. I would contact them, pronto.

who enjoy doing shit like this. :(

Little bastids making a name for themselves saving the insurance company money.

We need a better system NOW.

Sorry that you have to go through an appeal process. :hug:

crappy insurance. :(

:hug:

Good luck appealing it.

:)

:/

:hug:

I am so very sorry to hear that, ThomCat. It seems like the people in charge of making decisions have taken some major head truama in the New Year. x(

I hope that the appeal process goes off smoothly, and that some word from your doctor might make it easier for you.

Hang in there, babe.

:hug:

You obviously need the scooter, it should be what we like to call a "no-brainer". Instead you are denied what you need by a heartless insurance company. The system does not work. Time for a new system, sisters and brothers.

Not medically necessary? God knows I could testify otherwise. I'm so sorry you have to deal with this, Thom. :( :hug:

what's the address?

I might not quite have your muscle, but my grandpa was a geologist so he has a nice array of pickaxes and sledgehammers here... :evilgrin:

Goddam but this infuriates me! :grr:


I'm glad you have docs who will go to bat for you, though. Keep us updated, okay?

Assholes.

I hope you win your appeal, Thom. :hug:

show up at their door and ask them in person...

fucking sucks Thom

the world has become a giant compassionless void it seems sometimes

:hug:

bet if you stuffed one of those crutches up their &!! they'd see the necessity! I hope the appeal goes quickly!

he'd do it too. :)

operate one before they'll approve it. And then they'll only approve it to be used IN the house and not outside.

The main requirements for approval:
• Be bed-confined and chair-confined without the use of a wheelchair or scooter
• Have severe weakness in your shoulders and upper arms
• Be unable to operate a manual wheelchair


If you can do any of those things, you're shit out of luck. We had to buy my scooter out of pocket.

I think that sometimes you have to be near dead to have a "medical necessity". Don't even get me started on the racket called "long term disability"...Appeal to your state's insurance board. Thats the best way, but thats slow as molasses sadly.

Hopefully it won't take jumping through hoops to get them to overturn the decision. I think sometimes they just automatically say no hoping you won't push but with the right documentation from your doctor(s) they probably won't argue it on appeal. :hugs:

Sorry to hear this, ThomCat. Hope it works out the way Connonym said, with the right documentation.

:hug:

Keep trying!

I hope it works out for you.

I am so sorry Thom! "Not medically necessary" :wtf: I can't imagine at what condition you need to be in for them to be deemed as such.

:hug: :hug:

~MB~

A lot of this is an overreaction to the scam artists you see all the time hawking scooters on teevee and in Spam to people who may or may not even have disabilities. The scammers then proceed to bill Medicare for a full power wheelchair, at ten times the cost of the scooter. Charming.

http://www.myfoxatlanta.com/myfox/pages/Home/Detail?contentId=4978763&version=1&locale=EN-US&layoutCode=VSTY&pageId=1.1.1

Again, this is the sort of thing your CIL could be handling, but yours just doesn't seem to be getting it done. (sigh) If you were out here, we'd be on top of it...

Did you know? DU has its own Disability Forum in which we hash these sorts of issues out constantly.

http://www.democraticunderground.com/discuss/duboard.php?az=show_topics&forum=250

edit: link

I hope it works out for you even though you may have to fight red tape.

Doesnt one of those scooter companies promise that they will get it to you no matter what
if the stupid insurance denies?
I think its Tom Kruse or something....:shrug: :hi:

Which means they check with your insurance and/or medicare/medicaid to find out if they're likely to be out a scooter. That's just a marketing ploy.

Is the doctor that recommended the scooter associated with a hospital at all? If so, that hospital probably has a person that deals with insurance coverage issues and can probably help you out. The doctor's office may be able to point you to that person.

Also, you can try your state insurance commission's office as well as any Dept of Consumer Protection, too.

Wheelchairs, hearing aids, braces, etc. Some do, or pay for some things, but most don't. Even good private coverage. Mine doesn't, nor has any corporate or government insurance coverage I've ever had.

A friend with CP has to use a home equity-type loan to pay for her wheelchair and walkers.. and she has terrific insurance.

maybe 3-4 years back. The insurance company actually paid for having a special deck with a long ramp installed by his back door because he could not go up & down stairs. I was surprised.

So, it can't hurt to try.

but, I guess using bottom-line logic, if he was able to get into work and do his job, the company would not have to pay for long-term disability anymore. If he was not able to get out of the house, the company would continue to have to pay LTD. So, spending a few thousand for a small deck & ramp is peanuts compared to picking up half of his salary for a few years.

Unfortunately for the guy, he had to have his other hip replaced a year later and has not really been able to get out of bed since. (He has other health issues and his long-term goal is now to be able to sit upright for several hours at a time...)

Just curious?

:hi:

:hugs:

If I was you, I'd fight the good fight at any cost. Good luck! :hi:

Because they sure as hell don't actually *help* their customers.


:(