I need a lawyer

by **InTenSity** Wed 15 Feb 2017 - 17:15

In Florida who can help me with insurance issue.

by **Watch Out Pylon!** Wed 15 Feb 2017 - 17:25

by **Floyd Robertson** Wed 15 Feb 2017 - 17:34

I wish I knew a lawyer in FL who loved to take on insurance companies.

by **kingstonlake** Wed 15 Feb 2017 - 17:47

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

by **The Pantry** Wed 15 Feb 2017 - 18:18

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.

by **DWags** Wed 15 Feb 2017 - 18:24

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.

by **I.B. Fine** Wed 15 Feb 2017 - 18:31

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.

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

by **InTenSity** Wed 15 Feb 2017 - 18:43

I've reached out to him. Check your voicemail...

by **Dendrobates** Wed 15 Feb 2017 - 18:46

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?

Nope. We're all still crazy.

by **tGreenWay** Thu 16 Feb 2017 - 1:50

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.

You don't need anyone's permission. Go ahead, you can do it.

by **Blanch32** Thu 16 Feb 2017 - 6:47

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.

oh the irony! lol

by tanfan! Thu 16 Feb 2017 - 6:53

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

I'll call you this morning. What's with the 517 area code? i just saw your message. Thought it was Trevor.

by **InTenSity** Thu 16 Feb 2017 - 9:20

I've had the same number since around 2000 or 2001. I've just been able to keep it, and its a lot easier to keep than let everyone I know, that I have a new number. That's basically it.

by **Robert J Sakimano** Thu 16 Feb 2017 - 9:28

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.

good point.

In person, I'm much more of a jerk than I am here.

by **InTenSity** Thu 16 Feb 2017 - 9:31

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,

by **Robert J Sakimano** Thu 16 Feb 2017 - 9:34

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,

man, that sucks.. I wish I had some constructive suggestions for ya. Hopefully you can get some legal assistance with this.

yet another reason why The Man sucks.

by **Watch Out Pylon!** Thu 16 Feb 2017 - 10:16

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,

Wow, that's shitty. Good luck dealing with those assholes.

by tanfan! Thu 16 Feb 2017 - 11:33

Ok, check your email. I just sent you how to deal with these assholes. Get the policy provision the plan administrator is relying on to deny coverage. Let me see it. Fuck them

by P Rob Thu 16 Feb 2017 - 11:40

F TANFAN!!!!!!!!!

by tanfan! Thu 16 Feb 2017 - 11:47

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.

by P Rob Thu 16 Feb 2017 - 12:26

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.

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.

by **tGreenWay** Thu 16 Feb 2017 - 13:40

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.

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

by tanfan! Thu 16 Feb 2017 - 13:49

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.

I gave the Orlando Sentinel some funny talking points. Assholes took the premium payments and refused to pay on the claim. ERISA is difficult shit to deal with, which is why I no longer do that kind of work.

by P Rob Thu 16 Feb 2017 - 16:15

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.

Glad to see you know dick about what I do. I need a lawyer 55953254

by **tGreenWay** Thu 16 Feb 2017 - 16:26

P Rob wrote:
tGreenWay wrote:

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

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.

by **Watch Out Pylon!** Thu 16 Feb 2017 - 16:27

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.

by **Death Roe** Thu 16 Feb 2017 - 16:39

Insurance adjusters are representatives of Satan himself.

by P Rob Thu 16 Feb 2017 - 16:52

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.

Glad to see you know dick about what I do. I need a lawyer 55953254

Try again. Maybe this time you won't have to edit your post.

by **tGreenWay** Thu 16 Feb 2017 - 17:08

P Rob wrote:
tGreenWay wrote:

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.

Glad to see you know dick about what I do.

Try again. Maybe this time you won't have to edit your post.

I added an "h" because I missed it while typing out "hey". You can see the change in Pylon's quote of my post, vs. how my post now reads. But nice deflection. My comment stands because it's true, unless you actually suck at your job. I gave you the benefit of the doubt, despite your posting history here, which strongly suggests you're a mindless dolt.

by **InTenSity** Fri 17 Feb 2017 - 23:20

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>!>!>!>!?!?!?!

by aualum06 Fri 17 Feb 2017 - 23:23

Mental retardation what is this the 1970s?

by MattyFresh Sat 18 Feb 2017 - 0:21

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

by **tGreenWay** Sat 18 Feb 2017 - 0:28

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>!>!>!>!?!?!?!

Jesus, that's ridiculous.

by **InTenSity** Sat 18 Feb 2017 - 7:21

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

How do you want me to get you the pdf?

by CheesySpartan Sat 18 Feb 2017 - 8:31

That is F'd up! Seriously?

by **DWags** Sat 18 Feb 2017 - 8:35

Get these assholes Tanfan.

by tanfan! Sun 19 Feb 2017 - 16:56

Intensity. I started a thread on the rcmb looking for erisa lawyers. I'm sure there are a few who can help you out. It's a highly specialized area of the law.

by tanfan! Mon 20 Feb 2017 - 15:16

Two guys pmed me on the rcmb advising they have partners in their law firms that handle it. Go to my thread on the rcmb. you might want to pm them directly.

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