United Brachial Plexus Network, Inc.

Hi,

I haven't posted here in a long time so I'll quickly tell my story. i am 27 with ROBPI, my arm is contracted,no hand nor tricep function, fingers are crunched into palm. The only surgery I had was to fase my wrist and my insurance covered that because I complained of my wrist falling asleep. I tried having mod surgery with Dr. Nath, but my insuranced denied me, then I went to see about 2 or 3 other ortho specialist that would not do anything to me. I don't go to physical therapy .

If you have had surgery or go to therapy how do you get your insurance to cover it if your arm injury is a pre existing condition?

Keep fighting, filing appeals write letters explaining what bpi is and how it physically affects your life and the pain you have get your PCP to write a letter also get Dr Nath involved his office contacted AETNA and helped get us approved just don't give up. I thought pre existing condition was no longer legally allowed to be used as a reason to deny treatment.

Pre-existing is allowed as a reason to deny insurance coverage. Thats crap in my mind! If you have a group insurance its not allowed but if you have private, it is. But it is only supposed to be a period of 12 to 24 months if I remember correctly. After that they have to cover some stuff like so many therapy visits per year and surgery with in-network docs. If there are no specialists in-network then they need to help cover the costs out-of-network. Call them until they are so sick of hearing your voice that they cover you so they dont have to hear from you again


Insurance is not fair at all! I just applied for my own insurance so my parents dont have to keep paying that too (trying to get a little more independent a little at a time) and I was denied for covereage because of "ongoing surgeries". I am pretty sure I wont be having any more surgery, how can they claim ongoing if I am not having any more? Its crap! Now for the apeals! UHG You just have to keep fighting with them!
Good luck!
Hugs,
Amy 20 years old ROBPI from MN

Edited to say that as far as managing to pay for all my stuff (surgery, PT, OT, chiro...) one 50 dollar payment at a time. Its not what they are asking for except my chiro, they agreed when they started seeing me to take 50 a month. As long as they accept the payments, they cant say anything. They can threaten but cant follow through. So if you are in need of treatment, go get it and pay for it in small pieces for a while. Its not ideal but it works. As a college student, I can not afford more than that a month.


Message was edited by: hope16_05

Here's my experience with an insurance company…

I decided to find a local Orthopedic Surgeon to get another opinion on my OBPI and have a Dr. that was considered “in network”. The ortho sent me for a set of X-rays. Several weeks later, I received a bill from the Orthopedic Center. It showed Blue Cross Blue Shield paying exactly $0.00 for the X-rays.

I had a copy of the policy, so I looked up what they are supposed to pay. It listed them as responsible for a high percentage of diagnostic X-rays. I called the Blue Cross 1-800 customer no-help line. The person that answered the line asked for name, SS#, address, phone, etc. To verify who they were speaking with.(They wouldn't want to give out the medical history of a valued customer.)

When my info is pulled up, the customer no-service person said that there was a note on my file. It said “The diagnosis is inconsistent with the age of the patient.” So I asked the obvious, what is listed as the diagnosis? Customer no-service said that this information could not be given out over the phone. I then asked if Obstetric Brachial Plexus Injury is listed as the diagnosis. I get the same line of bull. After a few more minutes of Blue Cross double talk, the customer no-service person realized they weren’t getting ride of the stubborn person on the other end of the line and decided to do their job.

They asked me to hold while they contacted the doctors office. The claim was resubmitted with a different code and the insurance company paid their portion.

That's my story and I'm sticking to it.

You asked about pre-existing conditions. Blue Cross list a 12 month wait if treated within 6 months of policy start date.

Ask your doctor to write a letter that explains the increased range of motion you will get from modquad.

Good Luck and NEVER GIVE UP!
Chris 37LOBPI

AETNA didn't care about increased ROM or more function. When the second letter from the PCP came saying it was to relieve pain in the neck, shoulder and back then it was ok and they would consider it but I had to find a network doctor to do the mod quad. Only after not finding one within 100 miles was I allowed to take my son to see Dr Nath. What do people do that have life threatening illness go through, or do they just give up and die. I can't imagine being in that situation. I truly believe they don't care about quality of life its not there life. Its all about the all mighty dollar not about people Mare