I need a lawyer

Floyd Robertson wrote:I wish I knew a lawyer in FL who loved to take on insurance companies.

DWags wrote:

The Pantry wrote:I will vouch for tanfan. Did not get the case (was not my decision to make) but was a great help in researching the case and explaining the legalities of a situation a few years ago. Want to thank him again.

I think most sane people on this board can separate a guys persona here with his professionalism.

I.B. Fine wrote:

DWags wrote:

I think most sane people on this board can separate a guys persona here with his professionalism.

Wait, .. there are sane people on this board?

DWags wrote:

The Pantry wrote:I will vouch for tanfan. Did not get the case (was not my decision to make) but was a great help in researching the case and explaining the legalities of a situation a few years ago. Want to thank him again.

I think most sane people on this board can separate a guys persona here with his professionalism.

InTenSity wrote:In Florida who can help me with insurance issue.

DWags wrote:

The Pantry wrote:I will vouch for tanfan. Did not get the case (was not my decision to make) but was a great help in researching the case and explaining the legalities of a situation a few years ago. Want to thank him again.

I think most sane people on this board can separate a guys persona here with his professionalism.

, here’s the response I received from XXX:-

After a review of the medical records submitted for Kyle therapy services, it has been determined services were done for developmental delay issues which are not covered under your plan. We did have these records sent out for an independent review and they agreed services were for a developmental delay.

We will be denying these charges, based on your plan.

Apparently the paperwork that was sent in indicated that the therapies were done for developmental delay issues. In order for it to be covered, it has to be medically necessary.

Regards,

InTenSity wrote:Ok. Here is the situation. I'm fuming right now, mainly because I don't know what to do.

My son has Down's, most everyone here knows that. We have him in therapy, because Florida sucks with helping, under a program called Early Steps, they are supposed to only cover 1 therapy, and we're responsible for the other 2. Early Steps picked up one of the other therapies for us, because my insurance only covers 60 sessions/year.

This is where I'm getting fucked. My plan says that 60 therapies are covered, both online and in the large PDF file. Nowhere does it say it only covers the first 25 therapies and then after that they will determine if the therapy is continuing for a medical reason, instead of a developmental delay. I get a notice in Dec, fucking December that they are asking for medical records from the hospital that go back to July. I'm just copied on teh letter that is sent to the hospital. About a week later I start getting letters that say the therapies are denied because they don't have the info from the hospital and I can be billed up to $900 for each month, right now there are 3 months. I didn't have anything prior to that, that I remember.
So 6 months after they decide to start denying all the therapy sessions. I'm getting calls from the hospital collections. They are now currently covering the therapy sessions again because it is a new year. Here is the response I got from HR.

, here’s the response I received from XXX:-

After a review of the medical records submitted for Kyle therapy services, it has been determined services were done for developmental delay issues which are not covered under your plan. We did have these records sent out for an independent review and they agreed services were for a developmental delay.

We will be denying these charges, based on your plan.

Apparently the paperwork that was sent in indicated that the therapies were done for developmental delay issues. In order for it to be covered, it has to be medically necessary.

Regards,

InTenSity wrote:Ok. Here is the situation. I'm fuming right now, mainly because I don't know what to do.

My son has Down's, most everyone here knows that. We have him in therapy, because Florida sucks with helping, under a program called Early Steps, they are supposed to only cover 1 therapy, and we're responsible for the other 2. Early Steps picked up one of the other therapies for us, because my insurance only covers 60 sessions/year.

This is where I'm getting fucked. My plan says that 60 therapies are covered, both online and in the large PDF file. Nowhere does it say it only covers the first 25 therapies and then after that they will determine if the therapy is continuing for a medical reason, instead of a developmental delay. I get a notice in Dec, fucking December that they are asking for medical records from the hospital that go back to July. I'm just copied on teh letter that is sent to the hospital. About a week later I start getting letters that say the therapies are denied because they don't have the info from the hospital and I can be billed up to $900 for each month, right now there are 3 months. I didn't have anything prior to that, that I remember.
So 6 months after they decide to start denying all the therapy sessions. I'm getting calls from the hospital collections. They are now currently covering the therapy sessions again because it is a new year. Here is the response I got from HR.

, here’s the response I received from XXX:-

After a review of the medical records submitted for Kyle therapy services, it has been determined services were done for developmental delay issues which are not covered under your plan.   We did have these records sent out for an independent review and they agreed services were for a developmental delay.

We will be denying these charges, based on your plan.

Apparently the paperwork that was sent in indicated that the therapies were done for developmental delay issues.  In order for it to be covered, it has to be medically necessary.  

Regards,

P Rob wrote:F TANFAN!!!!!!!!!

tanfan! wrote:

P Rob wrote:F TANFAN!!!!!!!!!

Ha Ha.  15 years ago Walmart denied paying a 100,000 life insurance policy to a widow because the husband died one day before he was scheduled to return to work.  He had reenrolled and was off from by pass surgery at the time of re enrollment in October of that year.  Well, he was scheduled to return to work March 1 of the following year.  He died the day before and because he hadn't been back to one work one full day, they denied coverage. In the meantime, Walmart kept accepting and cashing the premium payments even after he died and never sent back the premium payments. So, I sued them. Made all kinds of headlines here in Orlando. Evil Walmart screwing over a poor widow.  I crushed them under equitable estopple, which is a legal theory used to get back at evil adjusters like you.  Bwaaaa haaaaa.  Fuck Tanny!! I hate him!!! He just wins.

P Rob wrote:

tanfan! wrote:

Ha Ha.  15 years ago Walmart denied paying a 100,000 life insurance policy to a widow because the husband died one day before he was scheduled to return to work.  He had reenrolled and was off from by pass surgery at the time of re enrollment in October of that year.  Well, he was scheduled to return to work March 1 of the following year.  He died the day before and because he hadn't been back to one work one full day, they denied coverage. In the meantime, Walmart kept accepting and cashing the premium payments even after he died and never sent back the premium payments. So, I sued them. Made all kinds of headlines here in Orlando. Evil Walmart screwing over a poor widow.  I crushed them under equitable estopple, which is a legal theory used to get back at evil adjusters like you.  Bwaaaa haaaaa.  Fuck Tanny!! I hate him!!! He just wins.

I'm not evil, I'm fair and reasonable. In your case Wal-Mart was idiotic. Can only imagine the money spent on defense plus negative publicity.

tGreenWay wrote:

P Rob wrote:

I'm not evil, I'm fair and reasonable. In your case Wal-Mart was idiotic. Can only imagine the money spent on defense plus negative publicity.

Youre an insurance adjuster? Good job setting your career trajectory just high enough to clear a parked car.

tGreenWay wrote:

P Rob wrote:


Glad to see you know dick about what I do.  

Don't be so sensitive. I'm sure you're good at what you do. I'm saying it's too bad you didn't aim a little higher in an effort to make a real contribution to society. But ey, keep up the good work. You're a real winner.  

tGreenWay wrote:

P Rob wrote:


Glad to see you know dick about what I do.

Don't be so sensitive. I'm sure you're good at what you do. I'm saying it's too bad you didn't aim a little higher in an effort to make a real contribution to society. But hey, keep up the good work. You're a real winner.

. Developmental Delays: Occupational, physical, and speech therapy services related to
Developmental Delays, mental retardation or behavioral therapy are not Medically Necessary and are
not considered by the Plan to be medical treatment. If another medical condition is identified through
the course of diagnostic testing, any coverage of that condition will be subject to Plan provisions.

InTenSity wrote:Am I fucked now? Does my insurance seriously discriminate against disabilities? I just found this, so I'm assuming I'm screwed.

. Developmental Delays: Occupational, physical, and speech therapy services related to
Developmental Delays, mental retardation or behavioral therapy are not Medically Necessary and are
not considered by the Plan to be medical treatment. If another medical condition is identified through
the course of diagnostic testing, any coverage of that condition will be subject to Plan provisions.

WTF>!>!>!>!?!?!?!

umm what in the fuk, I want to see your plan documents, that provision can not be possible