out of luck and out of time-TRIGGERS

iVillage Member
Registered: 11-18-2003
out of luck and out of time-TRIGGERS
9
Fri, 05-13-2005 - 10:34am

i've hit a major dead end with my therapy. wonderful insurance only allows 52 visits per school year (9/1/04-08/31/05). as of yesterday, i have had 50. that leaves me 2 more visits between now and the end of august. so unless tdoc can get pdoc to convince the insurance company that i need more visits my therapy will come to a screeching halt in one week.


things here are bad and getting worse. and now with therapy ending, i don't know what i will do. my kids need a mother who is together, and right now i'm anything but. i'm scared, and at the bottom of a very deep dark hole with no way out.


if any of you have any suggestions, please let me know. i'm back in a place i haven't been in for some time now and things look more hopeless now than ever.


thanks for listening.


traci

iVillage Member
Registered: 03-25-2003
Fri, 05-13-2005 - 11:31am

Hey Traci...I have been wondering how you are doing.

iVillage Member
Registered: 04-02-2003
Fri, 05-13-2005 - 12:50pm

I guess you could call me a hot head, because I would keep calling pdoc until he calls the insurance company and told them to extend the number of visits. I swear I hate insurance companies. I work across the hall from our agency and they work hard, it is our Governor & Legislature that has messed us up badly.

I wish you all the luck in the world.
LOVE AND HUGS!!!!!
Carla

iVillage Member
Registered: 01-06-2005
Fri, 05-13-2005 - 3:48pm

Traci, im so sorry to hear your out of visits. you must feel devastated. i do have some ideas for you some your dr. will have to finagle to fool insurance company.

have doc contact insurance company to get pre-certification for more visits.

have doc submit an appeal.

have doc. submit claim under different diagnosis code.

if doc has another specialty, ie; internist,nuerologist etc. submit under that dx code.

i hope i've helped.

good luck!

valerie

iVillage Member
Registered: 04-02-2003
Fri, 05-13-2005 - 4:00pm
Valerie has some excellent ideas. I hope your doc is a good guy and will do that for you.
HUGS!
Carla
iVillage Member
Registered: 11-18-2003
Fri, 05-13-2005 - 5:03pm

thank you all for your suggestions and support. i have called pdoc only to find that he doesn't have office hours on fridays. i will call again monday to see if i can get in quickly. i was just in there on tuesday and because i'm sleeping so much he adjusted my seroquel down 50 mgs so now i am taking 300 instead of 350. i guess he thought the seroquel was making me sleep. anyway, tdoc is trying to get ahold of him as well to see what they can finesse the insurance company with to get me more visits. meanwhile, i called the insurance company and got a big 'no' when i asked if there was any way i could get extensions on my visits. so i don't hold much hope there.


then, i discovered today that my paycheck was short, in addition to ex skipping child support the month of may, so i'm flat broke without enough to pay for tdoc next week so i have to cancel my two remaining appointments until sometime in june. it just keeps getting worse. i can only hope that pdoc can get me more tdoc visits, but after talking to the insurance company today, i don't have much hope.


well, again, thanks for the suggestions and support. they are appreciated.


traci

iVillage Member
Registered: 01-06-2005
Fri, 05-13-2005 - 5:18pm

Traci, sometimes your docs' will wait for payment, even if it might mean a little extra in your payment when you pay later. explain to them the reason and see if you can get your last two in and pay later.

I just hope everything works out. if i can think of anything else to help you, i will let you know.

my wish for you is,financial gain, serendipity, and a hammer for your DH head! lol

valerie

iVillage Member
Registered: 11-18-2003
Fri, 05-13-2005 - 6:31pm

thanks valerie. i called tdoc earlier today and left a message for her to call me regarding the tuesday appointment. i still have not heard back from her. if she calls me back i'll talk to her about possible payments.


i will keep you posted.


traci

Avatar for schitz
iVillage Member
Registered: 02-06-2004
Sun, 05-15-2005 - 4:02am

((((Traci)))

I'm sorry things are so rotten, but I'm glad to hear from you. I've missed you. I wish that everyone would know that. I just don't have the energy myself to send out messages letting them know *hangs head in shame*

I don't know what to say. I guess the only thing that would work is to convince them that you need more! I don't know how it works for anyone else, but mine is at school and covered by OHIP. Even if I went to the community mental health centre (which I've been waiting to get into since Dec) it's covered by OHIP. (Provincial insurance that is- although we're becoming more american every day (no assault to my american friends) they have just gotten rid of chiropractic and optometry from the OHIP and we really don't get it free either, they have added it to our taxes. Frickin gov't. We've done bad with the liberals before. I actually thought a minority liberal government would be better because then the other parties would be able to pressure into getting some of their agendas taken care of, but that doesn't seem to be the picture).

Wow I am SOOOOO sorry for this post. I went way off on a tangent.

I just want you to know how much I care. I'm in a hole too it seems, so maybe if we dig forward instead of trying to climb up we can at least be in our hole together?! :)

Love,

Amanda

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iVillage Member
Registered: 11-18-2003
Sun, 05-15-2005 - 8:17am

no need to apologize ((((((amanda)))))). i think so many of us right now are bad places which is why i felt bad for posting my stuff anyway. i'm sorry to hear that your insurance has changed the chiropractic and optometry care. i know here in the states that's been a burr in my side for years........ever since i started going to a chiropractor in fact. i don't go near as often as i should now because my insurance doesn't pick it up. but i've lived the majority of my life w/o adjustments so i've adjusted back to living with the discomfort. working for a county government, other than chiro and mental illness coverage, the package is fairly decent. the physical health insurance is excellent. the dental coverage is pretty good and we do of optometry insurance. that's not as good as the others, but it helps take the sting out of the bill, especially when all three kids, along with myself, have either glasses or contacts.


along with my bp, i've dropped a lot of weight again. my tdoc is NOT happy about that one. on my tuesday appt. last week she even started asking me questions about bodily functions, thinking i'd developed an eating disorder on top of everything else. i just can't eat. my stomach feels like a volcano ready to blow and all it will take is sending food down there. so instead, i'm living on rolaids and propel (which is flavored water w/ vitamins added) so my argument to her was i'm getting calcium and vitamins. she wasn't convinced. i just don't know what more to do.


when i talked to my insurance company the other day they were very firm on not giving me more visits, so i don't think pdoc will get anywhere either which leaves me on my own between now and september, excluding 2 visits. i was reminded last night of a contract i signed with tdoc some time back, but i really don't know whats going to happen. all i can hope for is pdoc gets my meds right soon.


i hope you are feeling better soon. i'm sorry to hear you are having such a rough time of it too, as with everyone else that has replied to my post. i'm thinking of you.


traci