• Report: #979177

Complaint Review: Coventry Health Care, Inc.

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  • Submitted: Fri, December 07, 2012
  • Updated: Mon, December 10, 2012

  • Reported By: WebGuy — Pembroke Pines Florida USA
Coventry Health Care, Inc.
6720 - B Rockledge Drive, Suite 700 Bethesda, Maryland United States of America

Coventry Health Care, Inc. Denied my lumbar spine surgery | Bethesda, Maryland

*Consumer Suggestion: File an Appeal

*Consumer Suggestion: Check Your Policy!

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I went to an ER twice because of my back problem. The second time I was in an agonizing pain and after hours of pain medication I still couldnt move. The doctors did a MRI and diagnostic herniated disk.  Now I'm in my bed for 12 days, can't walk without pain and missing working, which meansno income.

I went to 3 neurosurgeon doctors and an Orthopedist, they all recommended surgery. The herniated disk is pretty big and its pushing my sciatic nerve. My right leg is numb and I have a horrible sciatic and back pain.

All doctors told me about getting treatment with epidural or asteroids injectionhowever, my case was diagnostic as extreme and the treatment would not take effect, even worse, it could do some permanent damage on nerves if I wait longer.

So my Neurosurgeon doctor scheduled my surgery and at the last minute my insurance company, Coventry Health Care, denied service. I have Coventry Health Care Insurance for about 5 years.

The reason that they are denying its because I need to be in a treatment for 3 months and then show that I still have no improvement.

My doctors told them that I can't drive or go to work...I can't wait 3 month to see IF they will approve my surgery. Meantime I will be without income. What now? I need to support my family, my kid and pay my bills. I think I will just have to go ahead with surgery on my own and then try to fight back with bills.

I live in US and still the health insurance here have the same policy as the poor countries where the corruption and money is the top priority. Insurance Companies make money, the rich gets the best out of it and leave the rest of population in situations like this.  What a shame! Sad!

This report was posted on Ripoff Report on 12/07/2012 01:48 PM and is a permanent record located here: http://www.ripoffreport.com/r/Coventry-Health-Care-Inc/Bethesda-Maryland-20817/Coventry-Health-Care-Inc-Denied-my-lumbar-spine-surgery-Bethesda-Maryland-979177. The posting time indicated is Arizona local time. Arizona does not observe daylight savings so the post time may be Mountain or Pacific depending on the time of year.

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#1 Consumer Suggestion

File an Appeal

AUTHOR: 312416 - (United States of America)

As a insurance policy holder, you have the right to file an appeal. Call your customer service number on your member ID and tell them you want to file an appeal. There are several levels of appeals. The first being a multi-displinary team who reviews your case. They will vote on if your case should be overturned. If this outcome isn't in your favor, you can file again. There will be a review of your case by outside independent physicians.  This is a very useful process and I highly recommend you pursuing.
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#2 Consumer Suggestion

Check Your Policy!

AUTHOR: Do-do - (USA)

For some reason, insurance companies are issuing policies (of certain types...but not all categories, apparently) that specifically and singularly exclude coverage for spine surgery.  I just happen to become aware of this while changing the deductuble and coverage on my policy to avoid astoundingly increasing premiums. You need to look at  your policy to see if this is excluded.  His disc surgery will cost him a lot.  But he shouldn't wait 3 months against his neurosurgeons' advice; compressed nerves often become irreparably damaged leading (of course) to a permanent deficit.

It wouldn't be a bad idea for him to contact his state insuance commission. Nothing to lose.
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