I have been denied medical care by my health insurance Optima Family Care/Medicaid. I was scheduled for a mastectomy Monday the 14th of September. I received a letter of denial on Thursday the 10th of September informing me payment was denied. Reason listed is no documentation of trial and failure of conservative therapy. I have had 3 surgeries and multiple rounds of antibiotics for the same breast over the last year. I immediately contacted my surgeon. I have contacted Optima and was informed I would be sent an appeal packet and that a members service case manager will contact me. I have yet to get an appeal packet, and I insisted on speaking to somebody that could help me. I was assigned a case manager. She has been trying to divert my attention from the surgery denial to my other health issues. I am a diabetic as well as other health issues. I have sent e-mails to every media source I could find online as well as elected officials. I sent e-mails to the White House, I received a call from Linda Brown at regional headquarters in Philadelphia, stating; my mail had reached the president and had been forwarded to her. That per President Obamas request they are to investigate my case immediately. I went for a consult with my surgeon to discuss my case. My surgeon had a peer to peer interview with the Optima Medical Director. The Medical Director wants me to have a procedure called breast conserving surgery. This procedure is usually done in skin and nipple-areola sparing surgeries. Not recommended in my case, since my entire medical problem is the nipple-areola and the surrounding tissue and skin. The outcome of such a procedure in my case is very poor. The medical director also stated; if I win my appeal for a mastectomy, they will deny payment for reconstruction and if I choose the breast conserving procedure they will also deny reconstruction. Janets Law gives me considerable protection for reconstruction, and the state of Virginia gives extra protection and mandates any insurer that provides coverage for a mastectomy must cover reconstruction. In the past year I have contacted both my PCP and Optima and requested to see a breast specialist and was told by both there was no such thing as a breast specialist. However there are breast-specialist. My PCP actually has my request in my medical chart. I feel this story needs to be heard not just for me but also for every American that has been denied necessary medical care by their insurance co.
Posts You May Be Interested In
It's been almost 2 weeks but I am still feeling like a pariah because I have to take meds to even get out of bed due to multiple medical conditions- Sytemic Lupus, DDD, scoliosis in 2 areas of my back, herniated discs from C-2 to S-1, 5 compression fractures; 3 of which are pressing on my spinal chord.I am also being treated for severe osteoporosis with daily injections. I have been in Pain...
I'm a 23 year old man who has been sick now for 2 years and 26day. I say sick because doctors don't know what is wrong with me 2 years ago I went into the hospital because I was in so much pain I was having trouble breathing and I was extremely weak was not eating and had lost 35 lbs in a week. I was in the hospital for 2weeks they told me I had valley fever and that I had 3 growths in my left...