Back Pain Isn't Covered???

United States
June 23, 2012 4:39am CST
Today I had a trip to John Day to sign over the title to my trailer there. It was a long day...I left here at 9 this morning and didn't get home till 5:30 this evening. All that time I was unable to lie down so by the time I got home, you better believe I was in major pain. The problem is mostly in my back which, of course, means that I literally cannot move. Now, I've been dealing with this pain for a long time. When I talked to the doctor here in Pendleton, he informed me that my insurance will not pay for x-rays of my back! In fact, my insurance doesn't recognize back pain as any kind of illness and so they just don't cover it at all. Say whaaaaat? Mind you, this doctor is no longer my doctor and I was thoroughly unimpressed with him. His defeatist attitude grated on my nerves and I immediately told my insurance company that I refused to see him again. I have switched doctors. But, really, are there really idiots in these HMOs that believe this sort of crap??? I mean, who among us has never had back pain? And who among us can function to any degree, really, when we have severe back pain? Are there really people out there in charge of our healthcare that have no idea what this is like??? Give me a break. Frankly, I don't believe that doctor. Would you?
4 people like this
5 responses
@RitterSport (2452)
• Lippstadt, Germany
5 Jul 12
hi dear alaskanray, I dont believe everything these so called Gods in White say. My father was a doctor and I work for Workers Comp now so I got to work with medical reports and the like. but I cant imagine that back pain isnt covered by your insurance. I would investigate on that too if I were in your shoes. My former doctor also told me things which arent true. He said I got to enroll in that special program for diabetics or my health insurance would not pay for the diabetes meds any more. Sure that somewhere along the line I asked the insurance people and they said noooooo taking part in that program is totally voluntary.
1 person likes this
• United States
5 Jul 12
Yes, I totally agree with you. I have a healthy distrust of doctors to begin with and male doctors, especially. Besides which, my insurance, which is the same insurance I had in John Day, paid for back x-rays in John Day so why not Pendleton, right? Duhhhh...how stupid does this doctor think I am???
• Lippstadt, Germany
6 Jul 12
Dear alaskanray I hope your new doctor is a better choice for you. The doctor I see now is male and he is a total gem. He has helped me get better with that back pain in 2008 when I was released from hospital and their treatment didnt do me much good. He also monitors the diabetes carefully. I am so glad I can trust him and hope you have a trustworthy doc as well. Have a wonderful weekend, my dear friend.
1 person likes this
• United States
6 Jul 12
Thank you for your good wishes, my friend. I'm glad you have a good doctor. I had one, once, too. He was very pro-active in my care and didn't cut me any slack when it came to what needed to be done. Unfortunately, he is long gone now, up in Alaska. lol Oh, well. I did finally contact my new doctor Tuesday and went in and signed the release to get my records transferred. Once they have my records, they will call to set up an appointment. I hope it's soon. I'm on my last refill of my meds and really need to get new prescriptions!
@Maggiepie (7821)
• United States
5 Aug 12
Ages ago I went to one doc who told me dismissively that he didn't do "cosmetic surgery," which I suspected I might need. I had new mole, & it looked really weird & itched constantly. The next doctor I checked had it tested. Melanoma... Fortunately, he got it all before it had spread too far. ALWAYS get more than one opinion! MP
1 person likes this
• United States
5 Aug 12
You betcha! I did not like this guy's attitude at all! Sad part is my new doctor is up in Walla Walla...an hour away and across the state line. Long distance just to make an appointment. Yikes! Here's hoping she's a good one.
1 person likes this
@Maggiepie (7821)
• United States
5 Aug 12
Say a prayer! MP
1 person likes this
• United States
8 Aug 12
Always!
1 person likes this
@sid556 (31006)
• United States
24 Jun 12
Hi Alaskanray, It does seem that the insurance companies are getting worse and worse on what they will and will not cover. A few years back, I had cervical cancer and when I needed to go to a specialist for treatment, they tried to deny me. It infuriated me as I had to travel to get to this specialist and I found out about the denial on the day of my appointment. In order for them to treat me, they wanted like 200.00 downpayment which I didn't have so I wasted my time and gas for now good reason. I had to argue with the insurance company and eventually won and they did cover it and they did catch the cancer before it spread. Now at this point, I don't have insurance. I could not afford to continue it because at my work, it was going to nearly double. I do have it on my daughter and I have noticed that in the past couple of years, they are denying more and more tests and things for her. The last one was an MRI and I did not find out until AFTER the procedure. The doctor had already known it was denied, said nothing to me and went ahead with it. MRIs are costly. A little bit of questioning with the insurance company and I found that it was denied due to the way the doctor wrote it up. If I were you, I would call the insurance company. I have never heard that they don't recognize back pain. It is usually the result of an injury some on-going health issue. My mother was on medicare and had chronic back pain due to an old injury and also osteopherosis. All of her treatments and meds were covered as well as physical therapy.
1 person likes this
• United States
24 Jun 12
Yes, I'm on Medicare, too...as well as Medicaid. The Medicaid is supposed to pick up whatever the Medicare fails to cover so I should be covered, right? Your story reminds me of when I worked for the State. My insurance pre-approved my surgery and then AFTER surgery they said it was pre-existing so they only covered $1000 of it! I got stuck with $28,000 in medical bills and I'm still having to pay on them! The really bad part was, if they had determined this "pre-existing" condition was not fully covered BEFORE surgery, I could have postponed the surgery six months when it would have been covered fully! It's like they want us to suffer! Grrr! A lot of it is because of the idiot doctors, though, not knowing how to deal with insurance. Bottom line for me now is that I am changing doctors.
@sid556 (31006)
• United States
25 Jun 12
Yes, It does sound as if it should be covered one way or another. I'd be questioning them. Medicaid is what my daughter has and they have been denying stuff left and right.
1 person likes this
• United States
26 Jun 12
What I don't understand is that I was covered in John Day, but not in Pendleton??? That just sounds wrong to me. Just because I'm in a different county should not mean my coverage is any different.
@laydee (12815)
• Philippines
23 Jun 12
Frankly, I wouldn't be angry at the doctor because they're not the ones who make the rules of insurances, the HMO company does. I have come across the same with you. My aunt was required to have a huge cyst on her back removed, it was as big as a golf ball and it was really disturbing her in her sleep. Mind you, her HMO includes these sorts of things - excision of mass/cysts, the doctor said that she should make sure that they're going to cover the full amount because it was a difficult operation, when she asked them to be safe, they said they will. After the operation, the bill was around $500.00 but the insurance would only pay $25.00. Now the doctor and her were friends and have been friends for a long time now but it would have been highway robbery if the company would only pay $25.00 for something that is $500.00. Regardless the reports and photos showing that the mass was not the 'usual' mass, they wouldn't budge. She ended up paying for the remaining herself. You see, these companies are not run by medical professionals nor doctors. They're run with people who obviously don't have much experience in the real world of medicine. Therefore, their pricing scheme is general and not custom. They're good at selling their products but once the patient avails, there are fine prints. You should be glad that you were told by that doctor that xrays were not included in your HMO, they probably aren't and he's just saving you for additional costs. You should have confirmed this first with you HMO rather than taking sides. Have a great MyLot experience ahead!
1 person likes this
@laydee (12815)
• Philippines
25 Jun 12
Indeed! Someone who wouldn't listen couldn't possibly treat you! It's good that you have set your foot this time and I do hope that you find someone who would be able to give you the service you deserve. Yeah, do check with the HMO and be careful of those fine prints! They're not generally happy when you know what you're talking about and are happier when you just pay and they don't pay anything for you. hahaha... Good Luck!
1 person likes this
• United States
26 Jun 12
It's just insane that I move just one county away and suddenly have nothing but problems with my medical coverage. Weird, huh?
• United States
25 Jun 12
This happens quite a bit actually. And it happens more with independent doctors rather than medical groups because the money is coming out of the drs pocket rather than a covered plan for many dr.s in the group. Does your HMO cover urgent care or er. If so, go here to het your needs taken care of. One of my family members is having a similar problem with stomach problems. His insurance doesn't cover ct scans unless the blood work is messed up. Crazy.
1 person likes this
• United States
26 Jun 12
The crazy thing is that I never had this problem in John Day, which is about 1/8 the size of Pendleton. Now that I'm in Pendleton my medical coverage is not up to par with John Day? What's up with that?