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They Paid It!

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mandksiders I currently teach full-time working with K-4 grade students with mild disabilities. Find out more about mandksiders
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  • #1

    They Paid It!

    I am so thrilled I had to share...after battling with my insurance company since my ICD insert in September over a $5700 claim that they denied (though they paid everything else surgery related) they have FINALLY reviewed the claim and now have paid everything on it.

    I am beyond thrilled. I just didn't give up about it and refused to just accept why they denied it, had some help from Mayo who reviewed it on their end and asked insurance for a review as well and today I checked and insurance finally covered it all.

    I am so happy to have that stress taken off of me. On top of that, yesterday I was hired to teach full-time again, starting in August. I haven't taught for six years since I started staying home with my boys and now they will both be in school full time in August, so I started looking for a teaching job and yesterday I was hired to teach special ed at a local school. I taught special ed for nine years before I left teaching and am so happy to be going back!

    Thanks for letting me share!
    Kaye
    Tags: None
  • #2
    Re: They Paid It!

    Great news all the way around .. so happy for you Kaye.

    Pam
    Dx @ 47 with HOCM & HF:11/00
    Guidant ICD:Mar.01, Recalled/replaced:6/05 w/ Medtronic device
    Lead failure,replaced 12/06.
    SF lead recall:07,extracted leads and new device 2012
    [email protected] Tufts, Boston:10/5/03; age 50. ( [email protected] 240 mmHg ++)
    Paroxysmal A-Fib: 06-07,2010 controlled w/sotalol dosing
    Genetic mutation 4/09, mother(d), brother, son, gene+
    Mother of 3, grandma of 3:Tim,27,Sarah,33w/6 y/o old Sophia, 5 y/o Jack, Laura 34, w/ 5 y/o old Benjamin

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    • #3
      Re: They Paid It!

      thats great

      i cant believe you guys over there have to get insurance or pay for it yourself
      our goverment here pays for all medical costs, inless its like to your GP or something but thats only like $20 a vist but all hospiltil and hospiltil treatments are free
      i guess our dum goverment good for one thing lol

      Margi
      Margi*
      http://margi-inskeep.blogspot.com
      Forever Young

      I was diagnosedwith HCM at 6.
      Went into Atrial fibrillation so had a ICD put in at 16
      Went into Heart failure at 17
      Got a heart transplant at 21(2009)

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      • #4
        Re: They Paid It!

        Fantastic News Kaye!
        See - It pays to be a sqeaky wheel!
        Marc
        Diagnosed @ 48
        Saw Dr. Michael Debakey @ age 5 - "He's fine, just a little noisy"
        Father to 3 boys 22, 25, 29 (all currently clear - pending genetics)
        AICD - Valentines Day '08, Spark Plug replaced 11/14
        After much research, I had a Myectomy @ Mayo for my 50th Birthday '08
        Quietly going insane . . .

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        • #5
          Re: They Paid It!

          I'm happy with you!
          God Squad co-moderator
          Nothing is as gentle as strength and nothing is as strong as gentleness

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          • #6
            Re: They Paid It!

            Kaye
            When I saw the title "they paid" I was hoping it was you !!
            That is great news. One less thing to worry about is always cool !!!
            peace
            mariab

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            • #7
              Re: They Paid It!

              Congratulations!

              Stubbornness often pays when it comes to insurance companies.

              Margi, it's worse than you imagine -- we not only have to hope we get jobs that pay for part of our insurance (or pay it all ourselves -- which is too expensive for most people); then we have to fight with the insurance companies to live up to what they say they do. It's not a very sane system.

              Gordon
              Myectomy on Feb. 5, 2007.

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              • #8
                Re: They Paid It!

                Hello Kaye,

                I am very happy your insurance company finally came to their senses and did the right thing. Such a relief!

                Congrats on the job! I admire all teachers, but an extra thanks for teaching special ed kids.

                Be well, Janet
                Believe in the goodness of mankind.

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                • #9
                  Re: They Paid It!

                  Margi, it's even worse that worse than that.... the hospital and doctors inflate their charges and then strike a deal with the insurance company to give them a discount so the insurance company will pay 40%-50% of what the actual bill is, but if you don't have insurance, you have to pay the full amount. so we bill the people who HAVE money less, and the people who don't --MORE. horrible horrible horrible. and for all the money that gets spent, we still have high mortality rates compared to Europe for certain things.

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                  • #10
                    Re: They Paid It!

                    Wonderful news! I'm glad you stood your grounds with the insurance company. Congratulations on going back to work. Hats off to you
                    Esther

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                    • #11
                      Re: They Paid It!

                      We do not have to wait in the US to get in for routine surgeries, or not so routine, hip replacements, etc. Myectomies would not be performed elsewhere in the world as they are in the US. Part of the US healthcare systems problems are too much insurance making medical decisions. I really know that in essence a govt run healthcare system sounds great but look at Medicare and Medicaid. A physician cannot live off these 2 insurances. Can you tell I work in health care? Reimbursement is not good but I blame insurance companies not Dr's for driving health care costs up. Oh well this is to be settled by the big boys and not us little peons. As far as Kaye is concerned it proves to hang in there and be your own advocate. She did well!!!
                      Midge

                      Diagnosed in 1977, Myectomy in 1981 @ Mayo Rochester
                      ICD&Pacemaker 1996
                      Heart transplant March 19, 2004 @ Mayo Rochester
                      Mom of Kaye.

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                      • #12
                        Re: They Paid It!

                        [, Hello all, Thank you for the welcome to HCMA. This is my first post and congratulations to they paid it. I was diagnosed with IHSS in July of 2006 after my sisters death, I have underwent treatment with a beta blocker since. As of last Thursday, my cardiologist has informed me that I must undergo a myectomy at the Mayo Clinic, Its all new to me and my head is just spinning with many questions. If anyone could please shed some light on what I wil be up against, I will greatly apppreciate it. I am 50 years old, Married, and yes my wife is full of questions that I cannot answer. I currently and have been a high stress job for the past 20 years, Live in Southeast Iowa. On the 19th I have an appt. with my cardiologist for getting the surgery scheduled. Please advise, Thanks, Tom

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                        • #13
                          Re: They Paid It!

                          Tom-
                          I can't say what you are up against with a myectomy because so far I am non-obstructed and do not need one. However, I can say that you will be in GREAT hands at Mayo. They are an HCM Center of Excellence and the doctors there know their stuff. I go there now for my care of HCM and will not go anywhere else. My mom has gone there for 30-some years, she had a myectomy there in 1980 or 1981 (I was in the 5th grade so I can't remember the year for sure), had a heart transplant there five years ago. She is doing great.

                          Others here will chime in who have had myectomy's but from what I am told- they feel so much better once all is said and done. Oh, I am in Iowa as well.

                          Good luck,
                          Kaye




                          Originally posted by tschribe View Post
                          [, Hello all, Thank you for the welcome to HCMA. This is my first post and congratulations to they paid it. I was diagnosed with IHSS in July of 2006 after my sisters death, I have underwent treatment with a beta blocker since. As of last Thursday, my cardiologist has informed me that I must undergo a myectomy at the Mayo Clinic, Its all new to me and my head is just spinning with many questions. If anyone could please shed some light on what I wil be up against, I will greatly apppreciate it. I am 50 years old, Married, and yes my wife is full of questions that I cannot answer. I currently and have been a high stress job for the past 20 years, Live in Southeast Iowa. On the 19th I have an appt. with my cardiologist for getting the surgery scheduled. Please advise, Thanks, Tom

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                          • #14
                            Re: They Paid It!

                            Kaye, Thank you for the encouragment. I do hope that I am able to learn alot about what I am up against here. I am not even sure what to be asking the cardiologist come next thursday. Glad to hear the good news of your Mothers history. Tom
                            PS: Lovely weather again here in Iowa,

                            Comment

                            • #15
                              Re: They Paid It!

                              Tom,
                              If you go into the Septal Reduction forum and look at some of the archeived threads and posts, you will get an idea of what kind of things you may want to ask about, along with how to prepare and what to expect postoperatively. Remember, everyone is different, as are our experiences.
                              If I can help answer any questions, please PM me.
                              Linda
                              Onward and Upward !

                              Diagnosed 4/07 HCM with fixed & dynamic obstruction
                              Myectomy with resected cordonae tendonae 4/08 CCF
                              ICD 10/08

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