Susan H Jzp

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Ambetter - The worst coverage!!

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I have had ongoing back problems since 2014. Im 59 year old female.

I have been a fitness instructor until my late 40s. Fitness has always been an important part of my life. As such, I know my body mechanics very well and I know when something is not working correctly. I have degenerative disc, arthritis, bulging discs, etc.

When I began feeling weakness in my hips and down my legs, I knew this was not good. Prior to being referred to a neurosurgeon, I went through PT. My therapist recommended that I go to neurosurgeon. The neurosurgeon ran many tests, and ultimately requested an MRI this was in Dec 2020.

I have had MRIs in the past and always had to go through PT before Ambetter would approve. Having already done PT i was surprised when Ambetter denied it. My neurosurgeons hands were tied. I put off further testing, etc for a year.

A year in which my weakness continued to get worse, as well as my leg strength and my gait / balance has been effected. This was even noticed by my Pilates trainer. (Yes, I continued to exercise and do things to keep my strength up). Fast forward to Dec 2021.

My weakness is much worse and is more worrisome. I opt to self pay and lumbar MRI was done with a suspicious area in my thoracic spine noted. Ambetter approved thoracic MRI after I self paid, but the facility I went to is not in network, therefore, I paid for two MRIs out of pocket. I went back to neurosurgeon and it is determined that in need surgery due to spinal cord compression..wow!!

Go figure Ambetter!! (Im being polite here). Now that I have surgery scheduled with my very reputable and highly recommended neurosurgeon, Ambetter will only PARTIALLY APPROVE my surgery. YOU HAVE GOT TO BE KIDDING ME!!!

What else do they need to approve my surgery?? I am to the point that I am highly considering legal counsel.

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Loss:
$900
Cons:
  • Worst expereince ever
  • Insurance not covering much

Preferred solution: To have my surgery, that has been requested by my highly recommended, highly qualified and reputable neurosurgeon to be fully approved as requested. And STOP giving me grief when testing is requested.

User's recommendation: Don’t purchase Ambetter