krashleen
03-04-2007, 02:08 PM
Hi there, I have Chiari 1 malformation, retroflexed odontoid, Ehlers-danlos syndrome, thoracic outlet sydrome.
I took an early out from my self-insured company; last day worked was January 5, 2005. I had company sponsored insurance where the company that did the "buy out" of senior employees paid my insurance premiums for one year.
Fast forward 8 months, found out that my cerebrellar tonsils were herniated into the cervical spine area and that blocked the cerebral spinal fluid flow.
Had local problems find an experienced neurosurgeon, did a search on the internet and found a speciality NSG that could treat me, went to NY for an evaluation, found that I was a candidate for surgery.
I had the decompression, extraction fusion from my skull to c4, after conversations(phone) with Aetna PPO which I was allowed out of network benefit.
The conversations with Aetna were limited, the rep speaking to me was not very nice (of course, its their job to deny) but also they say that I was fully aware of my benefit coverage. I still stipulate that I should have IN network coverage due to the complexity of my case, the limited NSG that have knowledge of this condition.
I went ahead and the surgery, and appealed twice and was denied. My claim evidently was closed prior to surgery which I wasn't aware of. I was advised that I could go to another NSG and have the surgery done, but I elected not to do that with the urging of my DH.
Now that the surgery is completed all appeals within the structure of Aetna, and now the mediation of my own self-insured company is done, I have been told that I have ERISA rights which I had investigated, however I have limited funds to approach this. If I had the funds I would pay the NSG who I firmly believe should be paid at a higher rate of benefit than what they are paying. Aetna is also contending the necessity of a second NSG in the OR, and not covering at the benefit level stated. I have met all my deductibles for calendar year 2005.
I am probably in debt around 30K, and have no way to pay for these outstanding medical bills.
I am not asking someone to "second guess" the decisions I made, but provide insight on how to proceed from this point without declaring bankruptcy. No I wouldn't do that, but it seems that medical bills are almost the main reason that people in the US do this.
Aetna declared an 8% profit for the same calendar year, and its disturbing while its not a excellent profit it still is a profit. I paid 757.00 a month for the COBRA coverage due to my pre-existing condition. On so many levels they should have to make a higher level of payment to the doctors that saved my life(living may be the correct term), but due to some cognitive issues I may of made mistakes along the way prior to the surgery. I was started to have black-outs, seizures, and a second opinion from an in network nsg said I would be be better served going to NY for the surgery due to their expertise.
Aetna says thats all well and good and that they paid all that they will pay.
Do I have recourse? How do I proceed? I am now disabled, on SSDI and cannot afford huge legal fees, but want to squeeze a few more sheckels out of the mammoth of Aetna.
Thanks for reading my saga.
I took an early out from my self-insured company; last day worked was January 5, 2005. I had company sponsored insurance where the company that did the "buy out" of senior employees paid my insurance premiums for one year.
Fast forward 8 months, found out that my cerebrellar tonsils were herniated into the cervical spine area and that blocked the cerebral spinal fluid flow.
Had local problems find an experienced neurosurgeon, did a search on the internet and found a speciality NSG that could treat me, went to NY for an evaluation, found that I was a candidate for surgery.
I had the decompression, extraction fusion from my skull to c4, after conversations(phone) with Aetna PPO which I was allowed out of network benefit.
The conversations with Aetna were limited, the rep speaking to me was not very nice (of course, its their job to deny) but also they say that I was fully aware of my benefit coverage. I still stipulate that I should have IN network coverage due to the complexity of my case, the limited NSG that have knowledge of this condition.
I went ahead and the surgery, and appealed twice and was denied. My claim evidently was closed prior to surgery which I wasn't aware of. I was advised that I could go to another NSG and have the surgery done, but I elected not to do that with the urging of my DH.
Now that the surgery is completed all appeals within the structure of Aetna, and now the mediation of my own self-insured company is done, I have been told that I have ERISA rights which I had investigated, however I have limited funds to approach this. If I had the funds I would pay the NSG who I firmly believe should be paid at a higher rate of benefit than what they are paying. Aetna is also contending the necessity of a second NSG in the OR, and not covering at the benefit level stated. I have met all my deductibles for calendar year 2005.
I am probably in debt around 30K, and have no way to pay for these outstanding medical bills.
I am not asking someone to "second guess" the decisions I made, but provide insight on how to proceed from this point without declaring bankruptcy. No I wouldn't do that, but it seems that medical bills are almost the main reason that people in the US do this.
Aetna declared an 8% profit for the same calendar year, and its disturbing while its not a excellent profit it still is a profit. I paid 757.00 a month for the COBRA coverage due to my pre-existing condition. On so many levels they should have to make a higher level of payment to the doctors that saved my life(living may be the correct term), but due to some cognitive issues I may of made mistakes along the way prior to the surgery. I was started to have black-outs, seizures, and a second opinion from an in network nsg said I would be be better served going to NY for the surgery due to their expertise.
Aetna says thats all well and good and that they paid all that they will pay.
Do I have recourse? How do I proceed? I am now disabled, on SSDI and cannot afford huge legal fees, but want to squeeze a few more sheckels out of the mammoth of Aetna.
Thanks for reading my saga.