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  1. #21


    Actually he's in more today but the doc said it would be worse for a couple of weeks with the bone absorbing the minerals they put inside there.

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  2. #22


    He's on the mend and that's important and I'm happy to hear it. Please try to take care of yourself as well, he will be needing you.

  3. #23


    Prayers for you and yours Steve. hope the best for all. Don't know if you remember my great nephew Henry had reconstructive surgery and now a 2 year old dynamo and has a very sweet baby sister

    2012 Silverado

  4. #24


    Will be praying!
    Excuse the rust..I USE my truck.

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  5. #25
    Sr. Engineer
    Join Date
    Feb 2012
    Western Maryland/Wyoming


    Hope everything turns out well, Steve.

  6. #26


    So it looks like the healthcare insurance company is not wanting to pay for the procedure! Wow, how about that? Just FYI, they're United Healthcare.

    So, he's been in pain for like 18 months. They found a large bone cyst and no one would touch it except for a pediatric orthopedic oncologist, literally the regular orthopedic physicians would not see him, said he had to go to the super specialist.

    Now, United Healthcare is saying that the procedure was not medically necessary. Really? Just crazy. Making me very upset at them.

    - - - Updated - - -

    United Healthcare Services letter to us.

    The introduction starts off .... "Based on the information submitted, we have determined that the requested service(s) is/are not medically necessary."

    Then I guess they have an MD review all of this. This guy is (I guess) Alexander Y. Garibashvily, MD, Medical Director, Board Certified in Family Medicine. However, if they didn't make this so difficult for us, it would be comical because he's clearly using some type of voice transcription device that can't hide his broken English.

    I'm imagining a thick Russian accent.

    "Your doctor plans a special procedure for your son. This is because he has a bone defect in pelvis. Doctor wants to fill the defect with synthetic material. We reviewed your health plan policy for those materials. We asked your doctor for records and notes. Based on available information the material your doctor requested for procedure would not considered safe and effective for this condition. For that reason this is not a covered benefit under health plan"

    What, it's bad enough that this decision is factually inaccurate, but they INSULT MY INTELLIGENCE by making me read these sloppy notes written in 3rd-world broken English. I mean, come on please.

    Examples of broken English from Alexander Y. Garibashvily, MD, Medical Director, Board Certified in Family Medicine.

    #1 "...he has bone defect in pelvis."
    Yeah, in English it's considered proper to include an article, maybe include a possessive pronoun as well. Might I suggest "... he has a bone defect in his pelvis."

    #2 "Doctor wants to fill the defect with synthetic material."
    Gee Wiz, Alex! More of the same with you huh? At least this time you moved things around a little bit. Let's keep the grammar train a rollin' and offer up another pronoun and an article in here as well. How about "Your doctor wants to fill the defect with a/the/then synthetic material." How's that suit you?

    #3 "Based on available information the material your doctor requested for procedure would not considered safe and effective for the condition."
    I could go on and on that this statement is factually incorrect and in fact total and utter BS. However, I can't get to that yet, Alex buddy, before I take you to task for really just screwing up this whole sentence. Next time, put down the crack pipe and consider rephrasing your nonsense with something like this, "Based on information available to us, the material that your doctor referenced and requested to use for the common bone graft procedure, which has been in use for decades and is commonly called "bone cement" (and it even has it's own Wikipedia page), is not be considered safe and effective for the condition."
    Last edited by ChevyFan; 04-21-2014 at 07:49 PM.

  7. #27


    Steve - my sympathy for your frustration! I had a cople of thoughts, maybe it's time to contact the Better Business Bureau. It is quite possibly a long shot but can't hurt anything. A letter, explaining your situation, to your state and federal representatives and senators may help. Just remember to avoid violating the first fact of life which is "Never start a conversation with 'Hey look, a$$hole!' ".

  8. #28


    The hospital is going to bat for us (and for them to be sure ... lol). Turns out that insurance companies do this all the time I guess and if they can delay payments for 2 weeks, well that let's them have the money in their accounts for another 2 weeks so they can collect interest on it.

  9. #29
    Caddiac's Avatar
    Join Date
    May 2011
    Upstate South Carolina
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    Insurance companies are like brothels except insurance companies don't keep up the end of the deal. Push for payment as hard as they are pushing to not pay. Lawyer-up if necessary. You don't risk ignoring that kind of problem. You know that, I know that, and all the parents on a potential jury know it too.
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  10. #30


    Steve sounds like thoughts and prayers are still in order all a round. Ours are with you. Damn insurance companies. ( that should be a thread of its own)
    As stated... Our thoughts and prayers for your son and you and yours.
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