Numbers
05-23-2009, 04:20 PM
So a little more than a month ago I had an implantable cardioverter defibrillator installed. I have a rare genetic heart disease called hypertrophic cardiomyopathy. Also know as "sudden death syndrome". Whenever you hear of an athlete or anyone else suddenly dropping to the ground dead, it's probably caused by an undiagnosed case.
My grandmother died from this disease. My grandmothers brother and sister died in their 20's and 30's from the disease. My uncle died last year from the disease. My mom has it, and I have it.
Afterwards, I get a letter from my health insurance that they won't cover it, as it wasn't medically necessary. Because, you know, I had this thing installed just for fun. In any case, assuming that they just didn't have my complete medical records, I had two of my doctors send them and appealed their decision.
I get another letter yesterday saying that my appeal was denied, and they won't cover it, as it wasn't medically necessary. Their specific reason for it not being necessary? "No history of cardiac arrest". So, basically, they're telling me that the only way they'd cover this is if I damn near died. Regardless that I get an echocardiogram once a year, and every year has shown a progressive worsening of the disease? People with this disease don't bounce back from a heart attack -- they die straight out.
What kind of fucking bullshit is that? I know that insurance company doctors are the bottomest of the bottom rung of medical practitioners, but how can they even swallow their own tripe in this case?
My uncle was one of the top cardiologists in the country. In fact, if it weren't for him, my family wouldn't even know we had this disease. Unfortunately my uncle passed away from it last year, but he had the worst case out of all of us. But his medical connections to our family are still there. My cardiologist is one of the top in the country. He works at one of the top cardiac hospitals in the world.
And some country bumpkin doctor in Kentucky is going to tell him that he was wrong? They're going to tell me and my family, who've been devastated by this heart disease, that a preventative ICD is not "medically necessary?"
I'm obviously furious over this. I'll be calling my company's HR rep on Tuesday to see if we can sort this out with our health insurance reps. I'll also be calling all of my doctors to get them in on it to. At this point, I'm ready to fight this tooth and nail. If necessary, I'll even get a lawyer to fight it, even if it costs more than the operation would have. It's the principal of the thing. I'm tempted to fly down and spit in the face of this insurance "doctor".
Has anyone else ever gone through something similar with their health insurance? If so, how did you handle it?
My grandmother died from this disease. My grandmothers brother and sister died in their 20's and 30's from the disease. My uncle died last year from the disease. My mom has it, and I have it.
Afterwards, I get a letter from my health insurance that they won't cover it, as it wasn't medically necessary. Because, you know, I had this thing installed just for fun. In any case, assuming that they just didn't have my complete medical records, I had two of my doctors send them and appealed their decision.
I get another letter yesterday saying that my appeal was denied, and they won't cover it, as it wasn't medically necessary. Their specific reason for it not being necessary? "No history of cardiac arrest". So, basically, they're telling me that the only way they'd cover this is if I damn near died. Regardless that I get an echocardiogram once a year, and every year has shown a progressive worsening of the disease? People with this disease don't bounce back from a heart attack -- they die straight out.
What kind of fucking bullshit is that? I know that insurance company doctors are the bottomest of the bottom rung of medical practitioners, but how can they even swallow their own tripe in this case?
My uncle was one of the top cardiologists in the country. In fact, if it weren't for him, my family wouldn't even know we had this disease. Unfortunately my uncle passed away from it last year, but he had the worst case out of all of us. But his medical connections to our family are still there. My cardiologist is one of the top in the country. He works at one of the top cardiac hospitals in the world.
And some country bumpkin doctor in Kentucky is going to tell him that he was wrong? They're going to tell me and my family, who've been devastated by this heart disease, that a preventative ICD is not "medically necessary?"
I'm obviously furious over this. I'll be calling my company's HR rep on Tuesday to see if we can sort this out with our health insurance reps. I'll also be calling all of my doctors to get them in on it to. At this point, I'm ready to fight this tooth and nail. If necessary, I'll even get a lawyer to fight it, even if it costs more than the operation would have. It's the principal of the thing. I'm tempted to fly down and spit in the face of this insurance "doctor".
Has anyone else ever gone through something similar with their health insurance? If so, how did you handle it?