I got a letter from my LTD today. They really worked hard to find a reason to deny me. They are saying that because I had some weeks that I fell below 30 hours per week, that I can be denied. That can pick any week, not my average.
So, I am hoping that my new lawyer can help me with this as LTD pays quite a bit more than SS.
If you have or are considering buying LTD, please check out the requirements. Because I was having trouble working and the doctor put me first on a work from home and then on fewer hours, they are using it against me to get this.
It's not fair and I'm not sure it's legal. The sad part is that they might just get away with it. My employer had no idea that it was this way. They are currently trying to change their agreement with the LTD provider because of this. But that might not help me.
I'm not devastated. But it still sucks.
We pay for all this insurance and then when we try to collect, they pullI live in Florida. My condo assoc was forced onto the State run Citizens insurance when no other insurer would give us a policy. Our insurance bill has gone up 700%. That's not a typo.
All insurance is a big con. Bleh! [QUOTE=itsmeepoo]
i cant even get insurance.. because i dont have a job
i cant get it through them and no insurance company will give me anything.
so my doctor visits now because im pregnant are 0 a pop, everytime i
walk through the door. and we wont get started on Enbrel costing me over 2
grand! wowwy!get laid off because "im not ready for the job" is no fun when
really they meant to say "we arent ready to hire a pregnant woman"
HOORAY! [/QUOTE]
WHAT????? This is ridiculous. 750 per appt. I cannot believe a doctor can
feel good about charging anyone, I don't care who, that kind of money. This
makes me mad!! You should look into SS disability. It makes me so angry to
hear this kind of stuff.
((((DEANNA))))
I am so sorry this is happening to you still. It's just ridiculous and so mean. And so frustrating to know how many people (insurance companies, etc.) just seem tohave absolutely no compassion. One of my sisters is dealing with this too, and has been for about 3 years for similar issues, and she is worn out. Don't give up. I am believing for you that this will be resolved in your favor SOON..
luv ya
tara
In response to my posting yesterday under the thread OFitsmeepoo -- you have got to be kidding!!!
Lynk -- you have got to be kidding!!!
CinDee -- I think we should tell the stories of what insurance companies are doing to us. It is one of the biggest stressors we have outside of the illness. Plus, when we start comparing stories, we learn about how to get around them, who not to use and someday how to win against them.
Tara and WatchingWolf -- thanks for the compassion. I'm not terribly upset because I was expecting it. My employer had given me the heads up that they were beating their own heads against the wall If I wasn't already talking to a lawyer about this, then I would be more upset. I have a friend that has been fighting for over 3 years for hers. This company has used every delaying techinique that they could and then pull this out of their hat at the 11th hour. They could have done this early one and it would have been more credible. I hope the lawyer can help with this just becaues now I really want to see them have to pay it out.
Cassie -- unbelievable!!! No wonder he is so cold-hearted if he's in that business. However, I do think if you hit him up for a very specific amount of money that his guilt (God-given, of course) might just cause him to open the purse a bit. I have seen God break down barriers in the coldest of hearts. Pray very specifically for that to happen. Maybe having a sister that has a terrible disease might soften his heart and make him change how he runs his business. There has to be a reason for this this is all happening. Maybe you should write a letter to him about how truly difficult this is all to deal with and then add especially when those closest to you turn their backs. Can you tell that I'm still mad at him for the way he is treating you? Unfortuately, it has taken years for my family to get it. I really suffered because of their cold hearts. But God let a lot of things happen in their lives to change their perspective. Now, they are truly becoming supportive.
I went through EXACTLY the same thing. I was on STD for a heart attack and many other things at the time... once the STD ran out the LTD was to have kicked in. NOT. I ended up appealing it twice and sought out an attorney specializing in this (at 60% (what a joke)). But in Michigan all insurance issues are classified as "Federal Cases". This is our system... and those judges are a majority for the businesses and the corporate. You have to understand that the insurance companies are the riches companies in the world because they say "No". Don't let them say "No". Seek out legal help and sue them. Trust me they will if nothing else settle for a MUCH lesser amount than what you can live on... but, at least after my 6 years of paying into it I got something. It was about a 1/8th of what they should have paid but, it was something.
Good luck dear... and remember that we are all here for you !!!
Olive, thank you so much for your posting. This gives me some hope because I did not know that they might actually do a settlement.
Man, what a tangle web this country has woven with all the ins and outs of health and other insurance. It is always biting us. And the only way you can seem to get help is pay out to another lawyer against the lawyers who figured out how to get the insurance company out of paying you in the first place. It seems everyone wins but us, the ordinary citizen.
Ins co hate bad press and they will often settle out of court to keep it quite.
They should re-fund your premiums at the very least.
My LTD is very expensive through work it is per month but it only really pays out when you are totally disabled and can't do any work.I have been paying on this plan for 6 years. I doubt I will ever see a penny, because I don't think I will ever be totally disabled (Christopher Reeves - superman - quadraplegia). Wish I had understood that and stuck the money in a 401k.
I'm so sorry, its just WRONG!!!!
If I fight this, I probably won't be able to take them up on that. It is so screwy. But it is a really nice thing for my employer to do because they aren't even the ones that should pay it back. They just didn't know this company was like that. I can tell that they feel really bad about it.
I sure hope it is 'fightable'.
They should be forced to publish claim filing instructions as well as stats on how well they payoff those claims. Like 93% denied and why, how long it took the client to get 1st check on a claim avg like 5 yrs and 3 months. Then you would know they were cheaters up front!
I had to jump through a lot of hoops to even get to read more tham a summary - thats when I learned it would only pay for total disability.
Deanna- i have applied for medicaid they are trying to deny me now. im not married but my boyfriend and i have our own apartment/ and he supports me (thank god) but he makes money not a lot by any means about 1400 a month (a good month) before taxes. its hard.. im terrified and now that im pregnant its an under statement to say i have put us in debt because of the doctor visits. i could goto the clinic but ive heard some very scary things and because im high risk and because i have RA i want the doctor that ive been seeing. i would do SS but i can work. not right now at this moment bc im not on enbrel but when i am i am very capable of working. im taking my time off now to try and find a job that deserves me :) ahah
on to Enbrel- patient assistance?! i didnt know there was such a thing! i think at this point id kill for enbrel.. i might just pay the 2 grand and get a months worth! i dont know
yes discrimination - i couldnt believe it when they let me go! im working with some people now who are going to fix it. like i told them i do not want my job back, i dont want money i want it to STOP! its not fair!! errrrrrgg ok im getting worked up! :deep breath: i thought all work from home jobs were scams???
RA + pregnancy + stress =
Thanks everyone. Fiona, thanks for reminding me how difficult it was because sometimes I just want to quit trying. It is so exhausting and demeaning.
Itsmee, I'm glad you've applied, but yes, your boyfriend's income could put you over. Have you filed yet for unemployment? That doesn't give you much but if they think it was an unethical firing, sometimes they can cause trouble for that employer. The other thing is that they can help find work that you can do. It can be a real help. They usually offer job counselling, have listings of jobs that are not advertised, give you Internet access to job boards, provide fax machines.
Regarding the Enbrel, you probably want to have your Rheumy apply for you with the Patient Assistance program. You might want to post a question regarding Patient Assistance for Enbrel. Those who have done it will be able to give you the best info. I did it for Remicade, not Enbrel. But there are lots of people on Enbrel here.
Also try posting work at home that really work. Some people are doing them, but I don't know the details. There's opportunities like medical transcription. It may be you can turn what you did at work into an at home opportunity. What kind of work or skills have you done?
Regarding your doctor and the clinic. Maybe you can discuss the expense with this doctor. It's possible that bloodwork and other tests could be done through the clinic and he could do the second opinion. This could save you tons of money. It seems that he should want to do something to work things out for you.
If you can't work things out then keep in mind that even the bills of a pregnancy will eventually be paid off. It just takes time. Sometimes, you can work something out with their billing department that might not be discussed by the doctor. It does not hurt to ask.
If you get denied for Medicaid, then you need to show that you have high medical bills. Some states have medically needy programs and the RA and pregnancy are probably going to qualify you. But you may need to push for this information. Check out your state's web site to see if there is a program like that. Not all case manager's are aware of these programs.
But pregnancy will usually get you in the door.
This is long, but if you read it all, it will tell you one of the reasons why Americans are having a hard time getting benefits. This is from a high school friend who lives in Washington, DC. He provides insurance to foreign students, etc.I checked this out on
"SNOPES", and it is TRUE!!!!!!
If its
happening in one hospital can you imagine how many other hospitals in CA &
TX & AZ, etc. are doing the same?
UNBELIEVABLE!!!!!!!!!!!!!!!!!!!!!
and this is just ONE hospital !!!!
1. John F. Kennedy
died there in 1963
2. Lee Harvey Oswald
died there shortly after
3. Jack
Ruby -who killed Lee Harvey Oswald, died there a few years later, by
coincidence. On the flip side,
A recent
patient survey indicated that 70 percent of the women who gave birth at
The average
patient in
The Dallas
Morning News article followed a Hispanic woman who was a patient at one of the
clinics and pregnant with her third child---her previous two were also born at
How long has this been
going on? What are the long-term effects?
Well,
another subject of the article was born at Parkland in 1986 shortly after her
mother entered the
Most of
these things are available to American citizens as well but only for low-income
applicants and even then, the red tape involved is almost
insurmountable.
Because
these women are illegal immigrants they do not have to provide any sort of
legitimate identification---no proof of income. An American citizen would have
to provide a social security number which would reveal their annual income---an
illegal immigrant need only claim to be poor and the hospital must take them at
their word.
My husband
is a pilot for the United States Navy (yes, he fought in
As I
mentioned, the care I have received is perfectly adequate but it's bare bones,
meat and potato medical care---not top of line.
Their (the
illegals) medical care is free---simply because they are illegal immigrants?
Once again, there is no way to verify their income.
There are
about 140 patients who received roughly million dollars for un-reimbursed
medical care. As it turns out, they did not qualify for free treatment because
they resided outside of
As if that
isn't annoying enough, the illegal immigrant patients are actually complaining
about hospital staff not speaking Spanish. In this AP story, the author speaks
with a woman who is upset that she had to translate comments from the hospital
staff into Spanish for her husband. The doctor was trying to explain the
situation to the family and the mother was forced to translate for her husband
who only spoke Spanish. This was apparently a great injustice to
her.
Sorry
for the length, but this needs wide circulation----particularly to our
"employees" in the Congress.)
Quote of the Day "Once
the coffers of the federal government are opened to the public*, there will be
no shutting them again." -Grover
Astounding. On top of this add that if you have insurance and cannot pay as I can't now because of disability, you cannot get any break. I am now being hounded by the hospital because I still have an outstanding balance for an ER visit that was 0 over what my insurance paid. I tried to get them to forgive the debt, but no, I had insurance so they wouldn't. That hospital ER is filled with illegal aliens. They actually go around now asking them if they would like to apply on the spot for state assistance.
Other hospitals are now charging patients who can pay more for services than they charge those without insurance.
That's right Deanna. My insurance was charged 00 for 18 hours in the hospital to have my son which I did without the comfort of any meds at all (it took me 10yrs to get pregnant so I was taking no chances). In all of the rooms around me were immigrants so I am sure my insurance paid for about 2 or 3 other babies births.
Hopefully, you will not get caught in the middle ground where you pay forever. But if you do, others have made it through. Your mother instincts will help you survive all that's thrown at you.
My niece just found out she is 3 1/2 months pregnant and is in worse shape financially than you. Her mom is being really supportive. Her boyfriend is still in shock, but kind of handling it. The family is ganging up on collecting baby stuff for her. Sounds like you have a great Mom. I'm sure you're going to be one as well.
After you have your baby, you'll have to post pictures. We love babies and animals here.
i can honestly say my child wont have the best of things but im gonna give her all the love i have. i did not want kids until later on in life and did not plan on having her, then i saw on TV how people were trying for years and years and couldnt get pregnant and here i am pregnant already and not wanting it. so i said to myself lets do it!! better now then when i cant be off my meds long enough to have a baby. so while im young and the RA hasnt completely taken over my life im going to do it. i told my boyfriend if he wasnt ready i would do it alone, i believe that much in this. i am so excited. i always said i was too selfish to have a baby - that all changes. im not saying i need this, i need to do this, i need to have this... its all what is good for my baby! and that is so different to me.....
but im glad i got on here now i know i have support and people that have been through what im going through. and i can get answers and ideas on what is out there for people who are going through similar situations.
k all i must goto sleep... being hounded by the dog and my boyfriend who have joined me in the bed! goodnite see yall in the morning!!!
and when baby is born there will be an explosion of baby pictures!!!!! cant wait!!!
I am so glad to hear how you feel about your baby. I was one of those that tried for years and years using infertility treatments, test tube babies you name it. One day 10 yrs later I was pregnant and hubby was 45 yrs old when I started screaming at him, I'm pregnant, I'm pregnant! He is now 15 and we love being older and raising him. Miracles DO happen.miracles definately do happy bonny!! i cant wait for this one to actually be here...
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