It's always my intent to keep this blog, our thoughts and words positive. However....when it comes to dealing with insurance companies and government entities - That ain't the way to have fun, son!
Not so breaking news: Anthem Blue Cross denied the claim for my allograft. To recap: the allograft is a joint sparing technology which implants living bone and cartilage into my knee. The technique has a high success rate of 80% to 100%
Once given the insurance companies decision, I then went through the exercise of submitting all the information to what's referred to as an Independent Medical Review through our friends, the California State Department of Insurance.
The case was sent by the State, to an Independent Contractor. The contractor is paid by the State (you and me, folks) to hire three "Doctors in good standing" to review and determine whether or not the insurance company denial should be upheld.
Their decision:
Dr. Shyster: Treatment is not the best option
Dr. Needelman: Treatment is not the best option
Dr. Cutter: Treatment is the best option
Two out of three win, so I'm all on my own, dear readers.
It was my understanding that the government's job was to serve and protect. These three doctors (I made up the names, if you didn't guess) do not reveal their names and have never met or examined me. Gee, I wonder if perhaps the State hires doctors that may side with them. Could it be?
For anyone who thinks it's a great idea to have the government in charge or our health care, think again. You just may end up at the mercy of Dr. Shyster, Dr. Needelman and Dr. Cutter.
Meanwhile, let's remain positive. Okay - I'm positive they turned me down!
Well written and well said. I must read more of your blog
ReplyDeleteACK! That is SO not fair! I can't believe they are alowed to make a decision without even seeing you!!! Grrr....OK, now positive prayers that SOMEthing works out for you to get this surgery AND it gets covered!!!
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