1 Jan, 2018 → by ClaimboUser558609
medical neglect and deficiency

1

Please help! I am disgusted and heart wrenched over the guidelines and protocol of florida blue insurance company (obama care). I am also baffled that florida blue insurance company can deny a request by a doctor regarding a patient's care. The following is an explanation per my telephone conversation with florida blue. My surgeon's office put in a request to florida blue for me to have back surgery on 10/18/2017. On or about 10/11/2017, I was informed by my surgeon's office that florida blue denied my surgery. I was also informed that every patient that has gone through their office with this insurance has been denied for some reason or another. The surgeon's office scheduled a peer to peer with florida blue, which was also denied. I contacted florida blue myself several times before I was able to get answers. At first, I was told that it was approved; I was given a reference number, codes, and dates of service. After contacting my surgeon's office back, they informed me that the codes and authorizations that were given were for the hardware that was going to be used in my surgery. After contacting florida blue again and asking for a supervisor, I was connected with jennifer trout. Jennifer told me that the surgery was denied due to: my bmi being a little too high, I was smoking cigarettes at the time, and I did not have an mri, physical therapy, or injections in the last 6 months. I explained to jennifer that I had back surgery in 2013 and 1 in 2014 and had 2 rods in my back already. Last year before my visit with the surgeon, my neurologist ordered a ct myelogram, which is an extensive test showing results or damage around the hardware in my back and previous surgeries. It took me 5 months to get into a visit with the surgeon's office. I had therapy last year before I went to the surgeon and the ct myelogram.in july 2017, I had a spinal stimulator trial put in my spine with the hopes that it would work and I could avoid surgery. Spinal stimulator: a type of implantable neuromodulation device (sometimes called a "pain pacemaker") that is used to send electrical signals to select areas of the spinal cord for the treatment of certain pain conditions. Scs is a consideration for people who have a pain condition that has not responded to more conservative therapy. Unfortunately, it did not work. I have been out of work since last november, no income whatsoever, homeless (staying at a friend's house for now), and I have $75 copays every time I go to therapy or surgeon. My help from people is running out. In my last conversation with jennifer, she told me that the surgery was denied due to: my bmi being a little too high, I was smoking cigarettes at the time, and I did not have an mri, physical therapy, or injections in the last 6 months. I have complied with everything. I had an mri, my last cigarette was october 11, 2017, I have been to therapy a few times which is not helping, my bmi is lower, because the weight the doctor's office had was the weight I gave them at my first visit. I actually weigh less with a lower bmi at the present time. I also had the spinal stimulator trial, which would be considered another "conservative therapy" before surgery. I had an appointment with my primary doctor, so everything is documented. I told florida blue if I needed to be tested for nicotine, I would have no problem complying. Last week, my surgeon's office resubmitted a request with updated compliance for authorization for the same surgery on levels l2-l3 and l5-s1. The surgeon's office contacted me to inform me that florida blue is now approving l5-s1, but is denying surgery on level l2-l3. This morning, I contacted customer service once again, only to be told that they have more stipulations. Apparently, the person from florida blue reviewing the surgeon's notes, radiology reports, and being involved in the peer to peer process does not feel that the surgery is warranted. There are currently 2 rods placed in 2 levels of my spine. I am not able to walk any distance without severe pain, I cannot attend art shows, walk stores, walk malls, carry groceries, hold or play with my grandkids, it's hard to walk stairs, and find it difficult to walk, stand, or sit for long periods of time without pain. I live in pain every day 24/7. I applied for disability several times and was turned down, because they feel there are jobs that I can do. I need help; I need back surgery. While speaking to a representative from florida blue, I was informed that I can file an internal appeal then an external appeal. I have emailed the florida blue complaint board, bill posey, insurance commissioner, consumer affairs, bbb, 3 tv stations, and the local newspaper. Today, I received an email that I was no longer connected to the patient portal for my surgeon's office. I contacted the patient advocate who informed me that I was discharged from the practice, due to florida blue denying 2 requests for authorizations for surgery and 2 peer to peer sessions, and cannot do anything else for me. How can florida blue get away with this? Please help! Sincerely, Donna zerlin [protected]
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