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AARP Medicarecomplete Secured
AARP Medicarecomplete Secured Horizons/United Healthcare Refund Promised not given/information needed for surgery in other state AARP won't give me w
5th of Aug, 2011 by User505207
There are several situations where AARP Medicare has not come through like they promised, but I will stick to the main ones for now. I would love to see this on Channel 12 Fox on your side in Boise, Idaho or all states. The situation I have been working on since 4/15/2010 has to do with a procedure that had to be done by Dr. J. Tuller DDS. Because of Brittle, Type 1, Insulin Dependent Disabetes since 2/1967 and radiation treatment for breast cancer in 1998, my bones will deteriorate and continue to do so for the rest of my life. I have already had 3 lower lumbar surgeries and now need from my neck C3-4 down to L2-3 fused at OSHC in Portland, Oregon.


Dr. Tuller told me to get ahold of Medicare because this should not be considered "Dental" (even though my representative told me vision and dental would be in place by 1/2010 among other promises not kept). This procedure involved removing all my teeth to prevent further infections and an upper denture and lower partial needed to be fabricated to aid in mastication, basically to save my health and life. That this procedure was Medically necessary. Due to Diabetic Gastroparasis (extremely comprimised digestive activity since 1980), it is critical that I am able to chew my food to help with digestion and nutrition. I first called AARP Medicare on 4/19/2010 to find out what was necessary to make sure this would fall under "Medical in Nature". I was told what was needed and I followed instructions to the "T". I did not even commit to this procedure until I made sure it would fall under "Medical in Nature". I was told 3 times it would before I committed to the procedure which began on 6/10/2010. I began calling every 2 weeks in July 2010 to find out the status of my claim. Each and everytime, I was told they could not find my claim...they would resubmit it..please be patient, this claim is "Medical". On 10/15/2010, AARP called me and I started in the the many times I've called. The person told me I didn't need to go on, this claim was approved under "Medical in Nature" and all they needed was proof the claim was paid in full so they knew who to write the check to (The amount was to be either $3,028 at 80% or $3,154 at 85% and that the oral surgery was basically a "no-brainer" it would be considered out-patient surgery) When I did not receive the refund by Mid-November. I called again and this was the first time I heard that they were missing one piece of information, but they would recommend an "override" to this policy, because it was not my error. There is so much more to this story, but I would be typing all night. I was told to appeal this case which I did and they first denied it because they do not cover Dental, which like I said, I already knew. I guess they denied it in January 2011, but I never received a denial letter so one of the Grievance Coordinators sent me another copy which I received 4/7/2011. So, again, I appealed, also sending a copy to the Attorney General and the Idaho Dept. of Insurance. This time they denied it because it was "not caused by an injury". Of course I argued with the Grievance Coord. on how stupid this sounded and on the many calls I made and the call from AARP on 10/15/2010 to find out who to write the refund check to. She told me there was nothing on the system about my many phone calls, however, I have a letter addressing that very fact and they would have training and education for their staff. She also said there was nothing on the system as to who to write the refund check to, but there was a request to find out if the bill was paid in full. Now...why would they want to know that if they were not going to give me a refund???? I let her know that nothing else better be missing off of the system. I have contacted several lawyers regarding this and they have all said I have an excellent case. Unfortunately, the ones who were willing to take my claim fees contingent on winning, could not for a few reasons. My claim did go to Maximus, which of course they denied it because AARP Medicarecomplete does not cover "Dental" No one seems to have a freakin brain in this Company. I followed intructions to make sure it would be covered under Medical. They told me this and even wanted to know who to write the refund check to. I have requested a hearing in front of the ALJ Judge and received a letter a few days ago. It stated they could not guarentee me that a Judge would even be willing to hear my case. I borrowed this money which put this person in a financial bind, but he knew I would get part of it back from what I was told, so he agreed. Again, I did not commit to this procedure until I made sure it would fall under "Medical in Nature. I am currently looking for a Lawyer to take this case fees contingent on winning. Now, to my other problem, which is quite critical. The surgery I need done in Portland, Oregon is very critical. My Doctor is concerned the longer I have to wait, the less chance of sucess or me even making it through surgery. I live in Boise, Idaho, but my Doctor is not confident with anyone here due to my critical health and nerve system and that is why I have to fly to Oregon. I was going to be able to borrow some of this refund back so I could get to Portland,Oregon. At the very least, I should have had this surgery done in November 2010. One of the Lawyers I spoke with said my case was extremely solid, except, I did not have the one piece of paper that said "We are writing me a refund check". My records are solid, the info on the system is solid if it is still there. So I called AARP Medicare complete to find out what was necessary to make sure everything was covered since it was in a different state. The PRS (a very nice and empathetic person) told me and then gave me a list of counties in Oregon that were considered "In-Network". I asked for this to be sent to me in written form, but he said their computer system couldn't do this. Yeah right...I worked for 33 years before becoming disabled and worked on a very complex system that went directly to the Dept. of Education. I told him just to hand write it on letterhead and make sure someone signed it. This was above his position description. I then talked with someone who is above the Manager position and was told the same thing. He said this was "Internal" (Private...within the borders of an agency) information and could not be sent out on written correspondence. But, it was alright to tell me over the phone. Sounds way too familiar to me. I'm thinking that once they told me over the phone, then it is no longer "Internal", but they would not change their mind. I know they are going to try and screw me over again. They will tell me the surgery took place "out-of-network" which would mean instead of me having to pay approximately $1,575 at the very least it would cost me $7,350 out of pocket not including the airfare, motel, meals and taxi fare. My Doctor is already extremely frustrated with AARP Medicare for many reasons, but this is going to piss him off royaly. He is going to try his hand at it. I NEED HELP, not only to get back the refund they promised, but to get it in written form the list of counties they cover in Oregon., so they can't screw me over again. As I mentioned earlier, I could even give you more cases where they have screwed me over. I will search out a resolution to this problem as long as I have to or as long as my health holds out. Being a Brittle diabetic for 45 years and dealing with more chronic pain and fatique than I can find words for, I am dying as we speak. It doesn't take a brain surgeon to know what stress, anxiety, pain, etc., does to a normal person, but you add diabetes to this formula and you have certain dealth. I am now dealing with a very painful rash caused by this stress, my Blood sugars go from 47 to 575 in 45 minutes which is not only killing brain cells but destroying every organ in my body (Doctors are amazed I have lived this long with this disease). As my so very wise son tells me "Mom, although your body is weak, your mind is strong and willful. Your pain is real, but suffering is optional and I know you choose not to suffer for you are a survivor". But I am so tired. I wished I could say this is the only thing that has gone on in my life....but as one Doctor put it: "I have gone thru more turnoil in the last 11 years of my life from medical, extreme financial hardship to situations that I have not control over, but affect me very badly, than most people deal with in a life time". He is impressed I go to bed at nite and plan to start all over the next day. But there are days I wonder if I ended up sick again from my diabetes, how hard I would fight to come back. Then I close my eyes and see my son, my grandson ( who himself went thru 3 open heart surgeries before he was 3 yrs old) and yes, my three Jack Russells and feel guilty I let myself get so exhausted, but sometimes, no, all the time, my health dictates what I can do in a day. It is so very important that I get to see my son and his family grow and enjoy life (He lives in Chandler, AZ) and while I am still healthy enough to enjoy it. I won't even get into what this government has done to me after working so hard, contributing like I was told to do...to not even existing. I do not feel sorry for myself...I want no one's pity or sympathy. I know there are people going thru much more. But it is time that I get what I should have without a fight all the time. The rich and the powerful need to get their heads out and really see what is going on here. Like I said, I could write you all nite what has taken place in my life. Some say I should write a book called "The Perils of Li'l _ _ _ ...a survival book for Life". Trouble is, I wouldn't know where to begin. Maybe it is the Pisces in me...who knows. I just know I worked for too long, too hard, to be going thru this kind of crap. AARP Medicare (as well as many other companies) need to "Right their Wrong" and do it ASAP, while I am still living. CAN YOU PLEASE HELP ME IN SOMEWAY...PLEASE !!!! As I mentioned, I would love to go to the media with this story if someone could guarentee my saftely. I know all about "Mass Media". I also have a Sociology Education. I so badly wished I could be working and using the knowlege I have from first having the gut feeling, then the education to back up with facts and now living this hell. Thank you

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