Need some good thoughts

shawn said:
There's no incentive to do it. It's not medically necessary and doesn't make anybody any money.
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But it could save them on potential future costs
 
Ron said:
But it could save them on potential future costs
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Not how these things work. Insurance is only interested in cutting current costs. Regardless, if you drop dead, doesn't cost them a penny.... Well, maybe the ride to the morgue?
 
shawn said:
Not how these things work. Insurance is only interested in cutting current costs. Regardless, if you drop dead, doesn't cost them a penny.... Well, maybe the ride to the morgue?
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Yes and no.

Heart attack leading to life flight or ambulance ride and emergency procedure is expensive.

This is the same reason insurance companies highly incentivize doctors to push for earlier and earlier colonoscopy screening, even though it costs $ now, its cheaper than chemo and advanced cancer treatment.
 
Ron said:
Yes and no.

Heart attack leading to life flight or ambulance ride and emergency procedure is expensive.

This is the same reason insurance companies highly incentivize doctors to push for earlier and earlier colonoscopy screening, even though it costs $ now, its cheaper than chemo and advanced cancer treatment.
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yeah, as well as weight loss or smoking cessation programs, or birth control.
Just like my dental plan has biannual cleanings and exams very cheap. Heck a prior plan used to give them free as long as you went every year.
Its like they have figured it out for very specific things but missed the big picture.
 
So the past couple of days has been a bit stressful. Dad knows he is pending 3 more stents to be placed. He also wants to be back in Michigan for the recovery process (cooler temps for the ability to be outside and walk and so on). They spoke with the Dr. who performed the initial stent and she said she has an opening on the 3rd of April. They got the hospital space yesterday and the Dr assured dad he will have no issue being on a plane by the 16 th (original flight home). The decision has been made to get the surgery done sooner than later and get him back to Michigan for the road to recovery. April 3rd he will go back under to get his “new” plumbing installed! I’m trying to figure out how to get out there to help close up the house and get them on the way back to Michigan.
 
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Out to dinner tonight and my phone rings. It’s mom and dad. Get the message that his insurance along with Medicaid has denied his upcoming surgery for 3 stents to repair 90% blockages around his heart. They claim that because he has not had previous heart issues that it’s not “deemed a priority”.


WHAT THE ACTUAL FUCK??!!

Am I supposed to call my auto insurance and say I might have a vehicle accident so when (if) it happens I could be covered??

I’m sorry but this is ABSOLUTE HORSE SHIT.

IM STILL GOING TO Arizona on the 11th and will be there to get them closed up and headed back to Michigan on the 16th of April.

On a good note his attending surgeon and her team have been in contact and they are fighting on his side to get everything approved and the hospital hasn’t let go of his appointment.

I’m pretty fuckin pissed right now but trying to stay positive.
 
skyhighZJ said:
Out to dinner tonight and my phone rings. It’s mom and dad. Get the message that his insurance along with Medicaid has denied his upcoming surgery for 3 stents to repair 90% blockages around his heart. They claim that because he has not had previous heart issues that it’s not “deemed a priority”.


WHAT THE ACTUAL FUCK??!!

Am I supposed to call my auto insurance and say I might have a vehicle accident so when (if) it happens I could be covered??

I’m sorry but this is ABSOLUTE HORSE SHIT.

IM STILL GOING TO Arizona on the 11th and will be there to get them closed up and headed back to Michigan on the 16th of April.

On a good note his attending surgeon and her team have been in contact and they are fighting on his side to get everything approved and the hospital hasn’t let go of his appointment.

I’m pretty fuckin pissed right now but trying to stay positive.
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Is there an option to pay cash and is it reasonable in price? I know some stents are basically an outpatient procedure these days.
 
skyhighZJ said:
It’s just not in the cards right now financially unfortunately. My folks are doing okay but on a pretty strict budget.
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I’ve seen gofundme’s for much less worthy causes, so I’d be happy to pitch in. Obviously if it’s $20k or something that doesn’t make sense. But if it’s $5k or something thing non-astronomical it might be worth giving it a shot.
 
jeepinmatt said:
I’ve seen gofundme’s for much less worthy causes, so I’d be happy to pitch in. Obviously if it’s $20k or something that doesn’t make sense. But if it’s $5k or something thing non-astronomical it might be worth giving it a shot.
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I don’t even know where to start and my “ friends circle” is so small I’m not sure where it would go. I feel like shit cause I’m so helpless in all of this. Yes we spoke on the phone. Yes he is okay, for now, but what about tonight, tomorrow, next week. But wait, he’s never had an issue so obviously there’s no a big problem.
 
skyhighZJ said:
I don’t even know where to start and my “ friends circle” is so small I’m not sure where it would go. I feel like shit cause I’m so helpless in all of this. Yes we spoke on the phone. Yes he is okay, for now, but what about tonight, tomorrow, next week. But wait, he’s never had an issue so obviously there’s no a big problem.
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First. Fuck insurance they suck.

Next - now that I’ve had a deep breath - don’t explode - yet. Pretty standard operating procedure to deny first request for any procedure over $X. Then when a doctor disputes it - it gets elevated beyond second week on the job Bob to an actual employee who has a brain.

They denied mom’s breast cancer treatment - as it hadn’t spread. Her oncologist who was the softest voice sweetest little Italian lady I’ve ever met - said ‘Excuse me let me walk to my office and call the physician line’ From at least 19 doors down I heard things that made me cheer and blush - including ‘I pray that a merciful God never makes you receive care determined from the same incompetent excuse from a company that signs your paychecks’ and suddenly not only recommended but also experimental care was covered in full.

My grandma was a Sicilian immigrant with the same middle name as moms oncologist - we all thought that was a good sign. That day I hugged her and told her Gaetana’s spirit had come down from heaven above and empowered her. She smiled and said - sometimes it helps to have Italian blood.

Prayers up for pops man. They will get this figured out.
 
A coworker's dad had the same thing happen a few weeks back after a heart attack. I don't think his blockage was that high though. Still really sucks.

I even had an MRI of my back denied. Then my DR had a peer review of the denial and it was granted. Hopefully he can have the same, like @Ron said.
 
Dad found out today that he has been denied and they had to remove him for the surgery schedule for tomorrow. His Dr. there in Arizona has forwarded everything to his pcm in Michigan. They are working together to reattack the insurance/medicaid ass wipes so when dad gets back to Mi he will be able to get the surgery done. Beyond disgusted with this whole situation. Don’t even know where to point a finger but not sure it would make a fuck even if I could pinpoint it. A man works his whole life on the up and up. Carries his own insurance that partners with Medicaid to then be told he is not a priority to receive a surgery that could very well be a life and death situation.
 
skyhighZJ said:
Dad found out today that he has been denied and they had to remove him for the surgery schedule for tomorrow. His Dr. there in Arizona has forwarded everything to his pcm in Michigan. They are working together to reattack the insurance/medicaid ass wipes so when dad gets back to Mi he will be able to get the surgery done. Beyond disgusted with this whole situation. Don’t even know where to point a finger but not sure it would make a fuck even if I could pinpoint it. A man works his whole life on the up and up. Carries his own insurance that partners with Medicaid to then be told he is not a priority to receive a surgery that could very well be a life and death situation.
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Still keeping your dad in my prayers.
 
skyhighZJ said:
Dad found out today that he has been denied and they had to remove him for the surgery schedule for tomorrow. His Dr. there in Arizona has forwarded everything to his pcm in Michigan. They are working together to reattack the insurance/medicaid ass wipes so when dad gets back to Mi he will be able to get the surgery done. Beyond disgusted with this whole situation. Don’t even know where to point a finger but not sure it would make a fuck even if I could pinpoint it. A man works his whole life on the up and up. Carries his own insurance that partners with Medicaid to then be told he is not a priority to receive a surgery that could very well be a life and death situation.
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😤

I’m not advocating for it - but it’s stories like this that make Mangioni seem more justified than insane.
 
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