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Jackie07 · 10-16-2009, 04:47 PM

Chelee,

Don't worry about the HMO. 'They should pay' (as my neurosurgeon had told us) for the treatment. Call the Vice President of your insurance company that's in charge of the special contract. Get youself a lawyer just in case. My brain surgery in 1990 was done outside of the network even though my then family doctor thought the network neurosurgeons were 'also good'. I came out of 23-hour surgery without any visible deficit because we had insisted on the neurosugeon in town that was recommended by my neurologist.

My then boss told the insurance company that 'Her [my] doctor is talking about lawsuit' while she's the one that had obtained a lawyer (someone who had just won the 'Texas Young Lawyers Award' the previous year) to work on my case pro bono. Eventually we did not proceed with the lawsuit (though my ex-boss still thought I should have,) but we did learn how to deal with the insurance company.

[2 years ago we had a leaking roof in one of the bed rooms and our insurance agent only offered to repair 'half' of our roof; because of our previous experience with the medical insurance company, my husband was able to get our contractor to talk to the estimator of the insurance company and got us a brand new roof. Another proof to us that the insurance companies are just going to try everything they could to pay as little as possible - even when they know they should pay...]

10-16-2009, 04:47 PM	#23
Jackie07 Senior Member Join Date: Jan 2008 Location: "Love never fails." Posts: 5,808	Re: Recommendation from my 2nd opinion... Chelee, Don't worry about the HMO. 'They should pay' (as my neurosurgeon had told us) for the treatment. Call the Vice President of your insurance company that's in charge of the special contract. Get youself a lawyer just in case. My brain surgery in 1990 was done outside of the network even though my then family doctor thought the network neurosurgeons were 'also good'. I came out of 23-hour surgery without any visible deficit because we had insisted on the neurosugeon in town that was recommended by my neurologist. My then boss told the insurance company that 'Her [my] doctor is talking about lawsuit' while she's the one that had obtained a lawyer (someone who had just won the 'Texas Young Lawyers Award' the previous year) to work on my case pro bono. Eventually we did not proceed with the lawsuit (though my ex-boss still thought I should have,) but we did learn how to deal with the insurance company. [2 years ago we had a leaking roof in one of the bed rooms and our insurance agent only offered to repair 'half' of our roof; because of our previous experience with the medical insurance company, my husband was able to get our contractor to talk to the estimator of the insurance company and got us a brand new roof. Another proof to us that the insurance companies are just going to try everything they could to pay as little as possible - even when they know they should pay...] __________________ Jackie07 http://www.kevinmd.com/blog/2011/06/doctors-letter-patient-newly-diagnosed-cancer.html http://www.asco.org/ASCOv2/MultiMedi...=114&trackID=2 NICU 4.4 LB Erythema Nodosum 85 Life-long Central Neurocytoma 4x5x6.5 cm 23 hrs 62090 semi-coma 10 d PT OT ST 30 d 3 Infertility tmts 99 > 3 u. fibroids > Pills CN 3 GKRS 52301 IDC 1.2 cm Her2 +++ ER 5% R. Lmptmy SLNB+1 71703 6 FEC 33 R Tamoxifen Recc IIB 2.5 cm Bi-L Mast 61407 2/9 nds PET 6 TCH Cellulitis - Lymphedema - compression sleeve & glove H w x 4 MUGA 51 D, J 49 M Diastasis recti Tamoxifen B. scan Irrtbl bowel 1'09 Colonoscopy 313 BRCA1 V1247I hptc hemangioma Vertigo GI - > yogurt hysterectomy/oophorectomy 011410 Exemestane 25 mg tab 102912 ~ 101016 stopped due to r. hip/l.thigh pain after long walk DEXA 1/13 1-2016 lesions in liver largest 9mm & 1.3 cm onco. says not cancer. 3-11 Appendectomy - visually O.K., a lot of puss. Final path result - not cancer. Start Vitamin D3 and Calcium supplement （600mg x2) 10-10 Stopped Exemestane due to r. hip/l.thigh pain OKed by Onco 11-08-2016 7-23-2018 9 mm groundglass nodule within the right lower lobe with indolent behavior. Due to possible adenocarcinoma, Recommend annual surveilence. 7-10-2019 CT to check lung nodule. 1-10-2020 8mm stable nodule on R Lung, two 6mm new ones on L Lung, a possible lymph node involvement in inter fissule. "I WANT TO BE AN OUTRAGEOUS OLD WOMAN WHO NEVER GETS CALLED AN OLD LADY. I WANT TO GET SHARP EDGED & EARTH COLORED, TILL I FADE AWAY FROM PURE JOY." Irene from Tampa Advocacy is a passion .. not a pastime - Joe Last edited by Jackie07; 11-06-2009 at 08:16 PM..