[Eddie G]

The insurance industry is set up to say no and wear you down while you are fighting them. They have the upper hand because while their employees are just doing their job in saying no, we the patients are gettlng stressed out and broke and emotional. They count on that. They also count on the patient to give up because many do. I'm not sure of the actual % that give up, but I'm sure the insurance industry does.
I have had my own personal struggle with the insurance companies. I got everything I wanted by NEVER giving up and played the game by their rules.

I actually have a case pending:

I went to a foot doctor because of foot pain. I was diagnosed with plantar fasciitis. I was given PT, a cortizone injection, and a prescription for orthodics to wear in my shoes. I needed to get prior authorization from Aetna for the orthodics which we got. I paid the co-pay, the orthodics were molded and in a few weeks I had them and used them everyday. We e e elllllll......
I get a letter a few weeks later saying that Aetna is really not paying for the orthodics because it is experimental and should not be one of the first treatments given for plantar fasciitis. This is after they had already approved it. So my foot doctor is appealing and was actually denied first appeal. We are on the second appeal with the doctor's office. If we happen to lose third appeal I can begin a lawsuit on my own since I would not have gotten the orthodics had they not been approved in the first place.
I think that someone initially approved the orthodics, then at the end of the month when the bean counters did their budget some red flags went up and they reversed those prior auths. like they never happened. Well I have all the papers approving the orthodics and that's what I went by so I trust Judge Judy to be fair & honest when I bring Aetna into her court for a couple hundred of dollars and alot of principle. Luckily I can spend time in court as long as I have a place to lay down.
I would also go to Judge Mathis. He's cool man!
So this is typical for insurance companies. I've gotten used to all this crap in the past 6 years. It's hard to keep a cool head when dealing with insurance people but try. It's frustrating having to micromanage your life surrounded by incompetants, but if you don't micromanage your life, nobody else is going to do it for you unless you're a multi-millionaire and can afford a personal micromanager.

Maybe Mark can add personal micromanaging to his list of patient advocate duties? I think Mark is way too nice to yell at the insurance companies the way they need to be yelled at. Maybe a gangsta rapper would be a good person to deal with them, better yet, state prisoners and we can pay them in cigarettes.


Or we can outsource to India...