By Brad on Tuesday, June 19, 2001 - 02:07 pm:

In 1993,when I was 39 years old, I suffered much because of a herniated disc in my lower back. 18 months later another disc went. I went through the standard treatment and PT and I never fully recovered. Often, even when just standing, I felt my back was so unstable that my back would just buckle over. Many times I couldn't get out of a chair. Since then I have been diagnosed with DDD in my lower back and neck.

Because of constant medical problems my primary care doctor sent me to a Physical Medicine and Rehabilitation Specialist. He performed prolo in my lower back and it did seem to stabilize my back, so more treatments were scheduled.My back has not felt this stable in years!

All the treatments were covered by the insurance company[compcare], but now, nearly a year later, they consider prolo as being experimental and the are saying that I am liable for $10,004.46.

Any suggestions ,comments or advice would be appreciated.

By Pat Martin on Tuesday, October 09, 2001 - 02:19 pm:

From "Prolo Your Pain Away" by Ross Hauser MD -- the Chicago Medical Society (a local branch of the American Medical Association) has given prolotherapy its stamp of approval on 3 separate occasions over the last 20 years. (pp51-53) I suggest you get a copy of the book and use the info in it to fight your insurance company.

By Park Griffin on Wednesday, October 10, 2001 - 02:01 pm:

Brad, one thing to check on is how the doctor coded your treatments. If your doctor coded your treatments in such a way that was not accurate to prolotherapy AND you were clueless that the coding was not accurate AND you were precertified for having treatments as was coded; you most likely can file a law suit against the doctor for fraud, but you probably would have to pay the 10 grand to the insurance company first. The reason for this is to show damages in a law suit against the doctor.

An easier way (on your part) is to see if there is a way that the Doctor can retract his billing to the insurance company and deal with you as a self-pay patient. On average a prolo visit billed to an insurance company ranges between 1,200.00 to 1,400.00 dollars per visit. On the other hand, a session of prolo that is paid for by the patient at the time of service ranges between 400.00 and 600.00 dollars.

By Mei on Thursday, October 11, 2001 - 11:25 am:

What is it with this d*mn world?! I don't get it, some companies that are supposed to be there to make life easier for those who are in physical need, insurances, disability offices, medical supliers, sometimes it seems as if they have made it their policy to make our lives difficult...
Why can't people (in general) just be kind, polite and helpfull!

By Park Griffin on Monday, October 15, 2001 - 07:03 am:

Mei, there is a department in insurance companies whose job is to make claims difficult. However, most companies use third party companies to scour over claims, not to make sure that it is appropriate for the insurance company to pay, but to try and find out if some other entity can be stuck with the bill (including the patient). These audits are done no matter how cut and dry a claim seems to be. My wife has had to use our insurance company quite a bit and we have filled out audit after audit, which has slowed up the continuity of care because our claims have been put on hold from time to time while they work out their audit.

One time I cut myself at home, it required stitches. The records from the ER visit explicitly stated that the injury happened at home and was not work related. However, I received an automatic audit. A five page form to fill out to make sure that the injury did not happen at work, or while on the clock for work, etc..., etc..., etc...,. The audit kept wording the same questions in different ways, trying to find an "out" for the insurance company. I was tired of these forms, so I through it away. My insurance company paid the claim and I have never heard back from this third agency again. WHAT A PAIN!!!

By Park Griffin on Monday, October 15, 2001 - 07:10 am:

Brad, I found out from a lawyer,if you appear stuck with the bill; retain a lawyer and in most cases they can get you a settlement for 50 cents on the dollar, which is better than paying 100 percent. Good luck!!!