Insurance - I give up!

[mbcube]

I now have had 6 doctors from one insurance medical group say I need an AICD implanted. 3 times this medical provider has denied claims.
I've contact an attorney and I'm prepared to fight. (I've been fighting this since October!) Wish me luck!

[mtlieb]

Good luck to you in fighting the insurance company!

I feel your pain, really. Life with HCM is tough enough isn't it? Without also having to constantly fight just to get decent care? It really does make you wanna throw in the towel. Hang in there though! From an insurance perspective, their job is to make sure you don't get the ICD. They make you fight for it knowing that a certain percentage of folks will simply give up and then they won't have to pay a thing.

Don't let them win. :cool:

[met]

One key to winning is finding out the criteria the insurance company uses to determine whether an ICD is appropriate.

Aetna, for example, publishes its "Clinical Policy Bulletins", and has one for ICD's (here's the link, see #8 for HCM being sufficient reason).

http://www.aetna.com/cpb/medical/data/500_599/0585.html

If you can get the similar criteria from your insurance company, that should help you make your case. In fact, if you're lucky, it may be as simple as having your doctors write their justification in a way that more precisely and clearly matches the criteria.

Good luck!

--met

[Midge Rollins]

You can tell them you will turn them into the state insurance commissioner. Have your EP call the insurance co and ask if they don't want what is best for their insured. Keep up the fight.

[mbcube]

Thank you all - The trouble is this provider is just playing dirty. Regarding criteria - Lord, they have quoted the AHA, (which does not even have HCM criteria), They put odd things in like 2 or more first degree family members with SCD under the age of 40 (and what about us lucky adoptees?) or my favorite - they keep discussing pacing therapy as not effective and we keep coming back that we are not pacing for therapy, but trying to prevent SCD!

Again 5 doctors have written letters, outlined standards of care for hcm and why this is appropriate. one doctor mentioned they are putting themselves at a financial risk by denying this!

I'll keep you posted (if I survive!)