Happy March Birthday To:
02 - Jeanie a.k.a. tnjeanie
19 – Nicol a.k.a. ajobeia
27 - Diane-Australia a.k.a. possum
28 - Judy a.k.a. cark777
Because we respect the privacy of our friends and we do not appreciate getting “spammed”, we do not give out e-mail addresses unless specifically asked to do so. Please stop by our message board to post your birthday wishes! And a note to you birthday people! Don't forget to check the message board to get all your well-wishes soon - birthday posts are removed after one month in order to conserve space!
It
is really great when you are in a chat and all of a sudden it becomes personal,
everyone starts sharing things about themselves that have nothing to do with the
topic. It brings us all closer and shows a level of trust knowing that no
one will repeat what went on in the chat room even if they yank our toe nails
out, well I might if they involve toenails ;).
I
look forward to seeing your tips sent into Sandra or myself concerning our
Anniversary Newsletter, these tips come from you - they are about what YOU have
learned from this disease or what might precipitate a flare or what you eat, or
do when you flare. Start sending them now to us please so we can put this
issue together, you can send them to me at Cooners@bestweb.net
or to our lovely editor Sandra at ChronniesChatter@yahoo.com
.
I
want to thank you all for the donations that you have made for Jan in her bowl a
thon - this is the only event that we are really involved in as a group.
So even if it is a dollar it makes a difference, please contact Debbie
and I can forward you her addy. Also be sure to read the newsletter
completely as this is Jan's turn to "Catch Up With".
Thanks for all your help in the past and for making this newsletter a happenin
thang ;)
Insurance
Talk by Lee Ann a.k.a. Gruppy
Insurance Rejections: What you can do
Month after month, you pay good money to have insurance coverage. Then when you go to the doctor and a test of some sort is ordered, the next thing you know is you get a little paper from your insurance company saying that service is not covered. Bummer. Did you know that most people will give up and quietly pay the charges without any kind of fight at all? That's what the insurance companies are hoping for. Don't be one of those people!! True enough, some things aren't covered, ever, and to help keep everyone's costs down, maybe those things should never be covered (I'm talking about things like cosmetic procedures...face lifts, chin implants, and that sort of thing, unless they are needed as the result of an accident/injury.)
But let's get to some things you can relate to...A while back, the drug Propulsid was pulled from the market after it had been proven to cause cardiac damage in some patients. Major stuff. The FDA recommended that all patients who had been given this drug have an EKG to determine if they had such damage. Guess what? After filing claims for patients, I received a ton of denials (this, the most common type of rejection, is not covered due to lack of medical necessity; a decision routinely made by someone, an MD, who doesn't see patients. He sits behind a desk and plays God. I personally have problems with someone who goes through all the expense and years of training to become a doctor so they can hide behind a desk working for an insurance company?!?!) So, what is the patient to do? Well, hopefully, your clinic has staff that will fight for you. (If not, discuss the issue with your doc at your next visit; he can make sure the staff is motivated to fight for you, especially if he understands your subtle hint that if insurance doesn't pay, you don't know if you can pay the whole thing, which he will hear as "if I want my money, my staff needs to take care of this.) That kind of claim should possess 2 codes. The EKG should go in as 93000, and the diagnosis should go in as V58.69. I know that's probably Greek, but let me explain. All procedures have a specific numeric code. All diagnoses have a specific numeric code. Those are universally used so that everyone can tell what is being done; otherwise, we would all get bogged down trying to figure out exactly what the doc means by a written description of what was done. The codes make it very simple.
The problem with this V58.69 is the "V" at the beginning. Insurance companies don't like codes that start with letters. They usually involve some sort of screening or preventive care, so they generally get rejected the first time around. What happened in this case is that the clinic resubmitted the claims, this time on paper, again with the EKG code and the V58.69, but with a letter of explanation attached. V58.69 is used for testing associated with the use of high-risk medicines. All of you on Imuran who have CBC's and liver profiles done have had claims submitted with the CBC and liver codes, along with V58.69 as the diagnosis. Insurance doesn't jerk you around as much with this code on lab, so you may not have had problems on that. A paper claim (literally, a claim submitted on paper, as opposed to the usual computer transmitted claims) will actually have to be handled by a person. Have one sent in, along with a letter explaining that you were on this drug, and according to FDA guidelines, you have medical need for this test. Don't send it without a specific name. Get the name of the head of the review department and send it there. If your doc's staff is feeling feisty, they can throw in something to the effect of no longer offering EKG's to their customers with that insurance company, since they don't pay anyway. They can just bill the insurance company later when the patient ends up in the hospital with a heart attack, which is covered, but which may have been prevented if the patient had had proper screening. Care to compare the expense of such a hospital stay to the expense of the routine EKG? And let's not overlook the possibility of damage so severe a transplant may be needed.
It's like I've posted and posted...you have to remind the insurance company that it will benefit THEM in the long term to do this little thing for you now. Don't give up. – Lee Ann
Upcoming Event - Bowl-A-Thon
AND
Catching Up With Jan a.k.a. JCO57
Hi, this is JanO. First off I would like to say I read the
message board often, but for some time now I have been having difficulty
posting. One time I can and then for a long time, it won't let me. Is it
something I say or did? LOL
The end of last year was busy for me. Our youngest son got
married and also adopted the son of his new bride! It was wonderful to see all
the love in that situation!! Then of course the holidays were very nice being
able to celebrate with family.
Our yearly Bowl-a-thon for CCFA, is coming up earlier this
year. It will be March 24th and I hope to get our family to participate once
again and raise a lot of money. One day this will all pay off with a cure,
or at least treatments that will work wonderfully! If anyone would like to
donate, I would be very happy to accept any amount for the cause. Please contact
Debbie
for my home address. Thanks so much for those who generously gave last year.
My health still needs work!! I have a rectal stricture right
now which is giving me daily pain with bowel movements. Surgeon doesn't want to
do anything for fear of making my bowel incontinence worse that it already is! I
understand that with the stretching procedure damage can easily be done, so we
are just hoping the new regiment of 6MP and Remicade will makes things improve.
I
miss the chats but seem to be busy that early in the evening (6 for me). I wish
you all good health and happiness and hope to get to visit more soon.
(Editor's note: Click here for highlights of the 2001 bowl-a-thon)
Tom's Recommended Links:
E-mail
chain letters, petitions, please forward this….We’ve all had our inboxes
filled with these things! Before forwarding them to everyone in your address
book, please check this site to see whether it’s legitimate or a hoax:
Like to play games? Here’s a site with LOTS of different kinds of games – pogo.com! (Sandra likes to play Word Whomp and Poppit!):
http://www05.pogo.com/index.jsp?sls=2
Here
is a great site for anyone new or still not very good at using a computer.
It's a FREE site, designed to help newbies learn more about the proper way to
operate a PC
For those thinking about donating money or things to any charity look over this site!!
Our Chronnies Chatter Of The Month:
Sayte a.k.a. BUMP
Our chatter of the month is Sayte AKA Bump Bumpinthenight and various names all with BUMP in front of them. Bump was a chatter from the first time we met her, and she got her nickname BUMP cos she was continually BUMPED out of the chat room. She has an excellent sense of humor, picking you up when you are down no matter how she is feeling or what she is going through. She posts her comments on the board on subjects that are pertinent to her and her knowledge. She is a great asset to our group and I encourage those of you who have not met her in person, to read her bio. Unfortunately, BUMP is so gorgeous that she has not give us her picture for fear of making the other girls jealous ;)
Congratulations BUMP and SAYTE ;)
Thought For The Day:
A
good listener tries to understand thoroughly
what the other person is saying. In the end he may disagree sharply,
but before he disagrees, he wants to know exactly what it is he is disagreeing
with. -Kenneth A. Wells
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