Had a bad accident

[ScooterWolf]

Forbes, sounds like you have a book in the making. Seriously, I would consider it.

- Wolf

[Forbes1964]

Forbes, sounds like you have a book in the making. Seriously, I would consider it.

- Wolf

My sisters tell me the same thing. To me it seems that it's just something that few others would be interested in. But who knows?


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[Forbes1964]

Gearing up for phase 2. The insurance company fight. I'm already seeing areas where the insurance company is going to give me grief. 1. Out of network charges. -- The accident happened at night. And out of town. And the anesthesiologists and night time surgeon were "out of network" as were several other doctors involved. So they don't want to pay their normal percentage 2. Getting prior approval for certain tests and procedures. Example: the Cat scan and other tests as well as some of the medical procedures.

Most of these fights will occur concerning the FIRST hospital. But a few disputes are from the Second as well.

I realize there will be significant out of pocket and co-pays. But if they think I'm going to pay 50+ thousand in out of pocket charges, they have lost their minds.
The home care nurse that I had for a while said that I could expect insurance company and hospital  fights and disputes to drag out for over a year before the dust settles. Oh well... At least I'm in good shape mentally. --- For now. [emoji23]
I'm sure the hospital will appeal the insurance decisions because they want to be paid. And they know that Cigna has more money than I do.


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[Forbes1964]

By the way, the charges if I'd had no insurance are 87,000 at hospital #1 and 83,000 at hospital #2 . Ambulance service not included. Again I'm VERY thankful for insurance. But MOST OF ALL , I'm thankful to God for life.


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[CROSSBOLT]

Backed into a corner with being put in the middle by big-shot insurance companies and lawyers pay 'em $2.00/ month and just WAIT for one to refuse the payment. Once any effort is refused the debt is paid in full. You will win in every court in the nation. OK, pay them $10.00/ month...the end result is the same in your favor.

Karl

[Mr. Paul]

Hey Forbes.  If you got your insurance through your employer, I would try to use their insurance department to help navigate all of this. In the end all of this nit-picking may be a moot point. If your insurance coverage has an individual yearly out-of-pocket maximum, that is all you are responsible to pay them. Most of the "negotiations" should happen between the hospital and your insurance company. If the insurance company gives you too much grief I suggest you contact your State insurance commisioner. In Georgia they do an excellent job of advocacy. At the very least, they could steer you towards some helpful resources. Sorry about the long post. Hope this helps you. Will be praying about this.

[ScooterWolf]

Took slightly more than a year (about 14 months) to settle with the insurance company of the left hand turner who cut in front of me. Having said that getting as much insurance beyond liability is so worth it. Had the other guy not have full insurance as well, my medical, dental and future cost would still have been covered by my own carrier

If your own or the other person’s insurance company does give you trouble getting the help of a lawyer is a good play as well.

- Wolf

[Forbes1964]

Hey Forbes.  If you got your insurance through your employer, I would try to use their insurance department to help navigate all of this. In the end all of this nit-picking may be a moot point. If your insurance coverage has an individual yearly out-of-pocket maximum, that is all you are responsible to pay them. Most of the "negotiations" should happen between the hospital and your insurance company. If the insurance company gives you too much grief I suggest you contact your State insurance commisioner. In Georgia they do an excellent job of advocacy. At the very least, they could steer you towards some helpful resources. Sorry about the long post. Hope this helps you. Will be praying about this.

Me complaining about another person's long post would be the ultimate in hypocrisy since I'm known to post without editing. Lol.
But yes, it is through my job. And there are out of pocket maximums. One for in network. And another for out of network. It is my contention that there should be Very few out of network costs due to the fact that it was an emergency situation. Also, they are saying that some procedures were not pre approved. So they don't have to pay. . But I'll let them and the providers hash that out. I'll wait until they are finished, then I'll jump in if the results are not what i feel are right. I'll go ahead and pay the out of pocket in network costs because there's no question that they are legitimate. And I'll willingly pay some out of network costs if they are legitimate. In the end, everyone will be paid since I received EXCELLENT care. It's just that I refuse to be taken to the cleaners because of a nit-picking, loophole seeking insurance company. I don't foresee any major concerns with the prosthetic leg and everything that pertains to it since there is time for everyone to get prior approval and also all those providers are in network.

[Forbes1964]

Another surprise. Motorcycle insurance policies don't automatically include PIP coverage. Didn't realize that until they told me after the accident. I had assumed that it was like auto insurance where PIP is included in the most rudimentary policy. Partly my fault for not reading carefully.But I would have thought that my agent would have mentioned pip when I bought the policy. But The scooter was covered. And thankfully I had Gap insurance, especially since I bought it with no money down and had made only ONE payment.

[Forbes1964]

Insurance woes aside, Thus far I have been able to keep up with my expenses thanks to a disability policy that covers SOME bills, and great people who stepped in with financial gifts. Some of you were in that number. Again I THANK YOU from the bottom of my heart. I find that I spend gifts and contributions more carefully than I spend my own money. If all goes well, I believe I'll weather this mostly  financially intact. That's worthy of giving God thanks for because I've seen many go into financial ruin. PRAISE GOD for his faithfulness!

[Forbes1964]

I'm not sure if I'll ever ride again. I think I could. But my family and other people that love me dearly would simply be PETRIFIED. So I'm factoring their feelings into my decision. But meanwhile, I'll ride vicariously through YOU GUYS. So share some GOOD STORIES!

[CROSSBOLT]

That decision to ride again is your decision and yours alone. Neither what we of the forum think nor what the family thinks changes that. Too soon anyway. Yes, DO NOT be a stranger! You are one of the qualified to give insight and guidance. You would miss some of us eating crow when our technical theories are proven incorrect and the apologies when some of us take ourselves too seriously (I'm talkin' about ME!). Well, don't be a stranger, anyway!

Karl

[Mr. Paul]

Sounds to me like you have "got this" Forbes. As far as you riding again, there is plenty of time for you to decide later. I do believe it is appropriate to consider the people that love you in your decision, especially momma! No matter what you decide, I also hope you will stay an active member here. If you are not going to do a book, how about a blog on your day to day progress and things. Including soap operas. 

[Stig / Major Tom]

Would not be the first to go to a used Miata cabrio for nearly the same thrills sans the danger of two wheels.
Stig

[ScooterWolf]

There's always the option of trying a trike, or a sidecar for more stability. Three wheels, or two, it doesn't matter to me. You'll always
be one of us.

- Wolf