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UnderGround Forums >> Help! $40K of my $250K insurance claim was denied


12/27/12 4:13 PM
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TheRaider
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I rhought I read that they covered 50k a year when I first read about it. Maybe it got used up in the first two surgeries.

More likely I am misremebering the amount.
12/27/12 4:29 PM
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ratataa
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Just to clear up any misconceptions ( at least those i've been pondering about)

Is Conor's employer aware of this dispute with the insurance company?
What is their (employer's) stance on the matter?
12/27/12 4:37 PM
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Mike Russell
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TheRaider - I rhought I read that they covered 50k a year when I first read about it. Maybe it got used up in the first two surgeries.

More likely I am misremebering the amount.
In total I think Conor mentioned the cost of all surgeries and rehab was in the neighborhood of $250,000, so Zuffa's insurance covered around 86% Phone Post
12/27/12 4:42 PM
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NINERS76
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My bad!! After reading the more detailed description of what happened I apologize. I know how hard it is to ask for help. Hope everything works out for ya. Best of luck in the future!!
12/27/12 4:45 PM
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Evzey
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TTT hope you get it sorted mate Phone Post
12/27/12 4:58 PM
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Orcus Knows MMA Better Than Goku
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Edited: 12/27/12 5:06 PM
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"Things got sketchy during the second procedure due to the density of my bones and they had to cut me open a lot more than anticipated. That's where all the blood loss and need for transfusion came in.

I was in the hospital recovering for 8 days."

 

sounds like the doctor screwed up...you may want to consider suing him...u say that the dr.'s job is to fight insurance for you...no its not...maybe hes fighting for you to deflect blame from himself

 

also u said that all the other doctors recommended a different treamtent...usually the overwhelming majority are correct..remember, he gets paid to perform on you so he is incentivized to advise you to go through surgery

12/27/12 7:15 PM
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Pat Giles
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mister3mma -
Orcus Knows MMA Better Than Goku -

"Things got sketchy during the second procedure due to the density of my bones and they had to cut me open a lot more than anticipated. That's where all the blood loss and need for transfusion came in.

I was in the hospital recovering for 8 days."

 

sounds like the doctor screwed up...you may want to consider suing him...u say that the dr.'s job is to fight insurance for you...no its not...maybe hes fighting for you to deflect blame from himself

 

also u said that all the other doctors recommended a different treamtent...usually the overwhelming majority are correct..remember, he gets paid to perform on you so he is incentivized to advise you to go through surgery

Awesome insight- did you donate money or just this? Phone Post
Irrelevant to the post. Everything isn't always as simple as its made out. Usually there's 2 sides to the story and then the truth in the middle. Phone Post
12/27/12 7:17 PM
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Orcus Knows MMA Better Than Goku
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mister3mma - 
Orcus Knows MMA Better Than Goku -

"Things got sketchy during the second procedure due to the density of my bones and they had to cut me open a lot more than anticipated. That's where all the blood loss and need for transfusion came in.

I was in the hospital recovering for 8 days."

 

sounds like the doctor screwed up...you may want to consider suing him...u say that the dr.'s job is to fight insurance for you...no its not...maybe hes fighting for you to deflect blame from himself

 

also u said that all the other doctors recommended a different treamtent...usually the overwhelming majority are correct..remember, he gets paid to perform on you so he is incentivized to advise you to go through surgery

Awesome insight- did you donate money or just this? Phone Post

no i didnt donate..i got mouths to feed and yearly medical expenses close to what hes paying for this one surgery...sorry, but y dont u dontate an extra 100 on my behalf

12/27/12 7:28 PM
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StretchPlum
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Often an exacerbation of a pre-existing injury can be covered, if the exacerbation was work-related. Naturally, one side in a legal matter doesn't make the determination whether they have liability on a unilateral basis. That's all the insurance company is trying to do. Also, the fact that an entity has not insured their liability doesn't mean they don't have any. Just a few general comments as hopefully food for thought.
12/27/12 7:42 PM
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JoeMimic
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I hope you get the help you need brotha, also props on wanting the fight with Pat even though you're hurt and unable to take it. Phone Post
12/27/12 8:37 PM
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BJ_Penmanship
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Conor-
I'm really bummed to hear that you're going through all this, man. I still remember rolling with you the week you joined 10th planet ( I had only found it a week before) and hangin at a few of Eddie's B-day gatherings. Always had good vibes from you and have regretted loosing touch... I admire your heart and the humble spirit with which you're handling this. Keep going brother.

To the rest of you bickering over health care and socialized medicine it's all got a price no matter where you are... If the UK and or Canada has all the right answers then why did GSP get his surgery done here in LA?
Socialized medicine already exists here in the US too, in the military. And it SUCKS HARD. Definitely not a model to follow for So many reasons.

Conor is good people. A tough bastard with a lot of spirit and good heart. keep that attitude and things will work out for you man Phone Post
12/27/12 9:03 PM
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MattyECB
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Mike Russell -

Let it be known for the record that Conor holds no ill will towards Zuffa, Strikeforce, or the UFC. They have been nothing but great to him and he isn't trying to target any of them with hhis campaign.

It's unfortunate that their insurance carrier chose to reject his claim for injuries sustained during his fight with Ryan Couture, but it's not surprising. Insurance companies aren't always as level-headed as they should be.

The point of this campaign isn't to makeStrikeforce, the UFC, or Zuffa look bad. It's to help Conor.

 

If that's the case he might want to change the thread title, goo luck Connor. Phone Post

This x 10.

 

Cindy

But it is technically correct as the policy is Zuffas. But everyone knows how cool and down to earth Dana and Zuffa is and how much they love their guys. It's clearly the insurance company and not Dana or Zuffa Phone Post

Cindy, I know your considered BLAF's link to the UG in alot of cases so it worries me you dislike the thread title.

Think logically here, Zuffa paid for an insurance company to cover its fighters, besides that Zuffa has no control over the insurance company.

Decision to deny or support and type of injury is completely independent of Zuffa, their only invovlement was being nice enough to foot the bill for any insurance company to cover injuries -- and quite frankly, this is the type of issue that would be encountered regardless of who Zuffa employs -- insurance companies gonna insurance company


It makes sense to write Zuffa's insurance policy because it lets everyone know, UFC brass included, that the company they're paying for and supporting is screwing over one of their fighters. At no point in the thread did Huen make up some conspiracy theory of Zuffa magically pulling the strings, and at no point did he imply that Zuffa chose a bad insurance company...

Thread title is just informative and accurate
12/27/12 9:14 PM
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MattyECB
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clown makeup - 

Someone needs to determine who authorized the additional surgery because it is a bit unfair to claim the following

"It's unfortunate that their insurance carrier chose to reject his claim for injuries sustained during his fight with Ryan Couture"

From the muddled information provided an injury occurred during the fight, the insurance authorized the repair of this. While being repaired the doctor noted a pre-existing condition which in the future could undo the repair he performed. The doctor went ahead and corrected that pre-existing condition and now the insurance company won't pay him for doing that correction. That pre-existing condition unrelated to the fight. They paid for the injury from the fight and will not pay for something else found unrelated to the fight.


You're forgetting though, a huge chunk of that bill is because of complications arising from existing conditions, i.e. his low bone density and other congenital issues.

But the fact of the matter is, if you have a pre-disposition to injury due to genetic or other pre-existing factors or need a different type of surgery and medical help because of these pre-existing factors, it doesn't change the source of the injury.





If a hemophiliac is fighting in the UFC, gets a broken foot, then has to have additional costs and alternative surgeries because he's a hemophiliac, it doesn't change the fact that all the costs and work are occuring BECAUSE he fought in the UFC and because he broke his foot, WHILE FIGHTING FOR THE UFC

Now lets say they invented a magical cure hemophilia surgery, then this surgery shouldn't be covered as its pre-existing, but more expensive surgery happening because of a fight-related injury should still be covered imo




The further surgery for hip dysplasia might fall better under your category, but additional costs like the blood transfusion seem like a clear case of what should be covered.

Not to mention, the seperate work for the hip dysplasia was necessary because of the current injury sustained in the cage. He had hip dysplasia his entire life and it never required surgery, he only needs it now because of the IN-CAGE injuries that are now leaving him exceptionally susceptible to further injuries of the like
12/27/12 9:16 PM
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Wally Saves
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I know of an Native American tribe that can loan you some money. Interest rates are reasonable. Phone Post
12/27/12 9:17 PM
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MattyECB
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Orcus Knows MMA Better Than Goku - 

"Things got sketchy during the second procedure due to the density of my bones and they had to cut me open a lot more than anticipated. That's where all the blood loss and need for transfusion came in.

I was in the hospital recovering for 8 days."

 

sounds like the doctor screwed up...you may want to consider suing him...u say that the dr.'s job is to fight insurance for you...no its not...maybe hes fighting for you to deflect blame from himself

 

also u said that all the other doctors recommended a different treamtent...usually the overwhelming majority are correct..remember, he gets paid to perform on you so he is incentivized to advise you to go through surgery


This is terrible advice through and through, I mean Jesus Christ.

The man is in financial troubles and is getting footed with an insanely large bill because of complications, and you think he should take on a malpractice suit that won't be settled for ages, even if he does somehow come out on top and win enough cash to overcome the legal costs.



And it doesn't sound like the doctor screwed up at all, if you have low bone density and that causes complications, then they might have to take an alternative route during the surgery. The fact that the doctor succeeded in spite of this issue means he performed above and beyond, not below what is expected of him.




And lastly, before you accuse the doctor of being self-interested and money-hunting, I think it's noteworthy that he's offering a large chunk of the work pro-bono because of the lack of coverage.
12/27/12 9:23 PM
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NINERS76 - 
Atkinson - 
Griffdog -
NINERS76 - I sure wish that I could start a fund and ask for money if my job doesnt pay for something. You made the decision to be a fighter and you knew the risk behind it. How about purchasing private insurance at a monthly rate instead of always turning to the fans!

I sure wish you would STFU, show a little respect, and never post here again.



Looks like we are both disappointed.
This... Obviously this clown has no idea how prohibitively expensive insurance for fighters is.. There was a doco on it recently and unless you're a top tier guy headlining PPV's etc it's something that many can't afford.

Have a heart Phone Post

Your right somewhat. Kinda take back what I said. From what ive read this surgery wasnt necessary. Your doctor seemed to want to test himself with this surgery. You might want to look into why the insurance wasnt contacted first.

how much is it for a fighter? i think i pay 900 a month.

12/27/12 9:49 PM
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Smith1234
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Conor, just an FYI, OMA broke his arm rolling (supposedly) and had no insurance. Came to the UG and got skewered from what I recall. You are getting much better treatment.

12/27/12 10:12 PM
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MMALOGIC
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Edited: 12/27/12 10:12 PM
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so zuffa's insurance paid 210k... and wont pay the remaining 40k?

12/27/12 10:30 PM
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aritwo
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Orcus Knows MMA Better Than Goku - 

"Things got sketchy during the second procedure due to the density of my bones and they had to cut me open a lot more than anticipated. That's where all the blood loss and need for transfusion came in.

I was in the hospital recovering for 8 days."

 

sounds like the doctor screwed up...you may want to consider suing him...u say that the dr.'s job is to fight insurance for you...no its not...maybe hes fighting for you to deflect blame from himself

 

also u said that all the other doctors recommended a different treamtent...usually the overwhelming majority are correct..remember, he gets paid to perform on you so he is incentivized to advise you to go through surgery


all the doctors suggested a treatment that wouldn't let Conor fight ever again

Conor's surgeon went above and beyond and allowed him to step into a cage again. he advised surgery so that Conor wouldn't lose his career and would be able to fight again.

The treatment was denied because the insurance claimed the damage was due to a congenital condition. The doctor/Conor are saying that the fight caused the damage.

a doctor fights for his patient because that is his job. doctors battle with hospital administrators and insurances all the time to get their patients the best care possible.

it is posts like this that make me so jaded toward patient care. you have a surgeon who spent years and years honing his skills to be able to be good enough to do the surgery to let Conor fight again. he is successful but because insurance is trying to get off on a technicality people want to sue him.
12/27/12 10:48 PM
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Orcus Knows MMA Better Than Goku
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Orcus Knows MMA Better Than Goku - 

"Things got sketchy during the second procedure due to the density of my bones and they had to cut me open a lot more than anticipated. That's where all the blood loss and need for transfusion came in.

I was in the hospital recovering for 8 days."

 

sounds like the doctor screwed up...you may want to consider suing him...u say that the dr.'s job is to fight insurance for you...no its not...maybe hes fighting for you to deflect blame from himself

 

also u said that all the other doctors recommended a different treamtent...usually the overwhelming majority are correct..remember, he gets paid to perform on you so he is incentivized to advise you to go through surgery


This is terrible advice through and through, I mean Jesus Christ.

The man is in financial troubles and is getting footed with an insanely large bill because of complications, and you think he should take on a malpractice suit that won't be settled for ages, even if he does somehow come out on top and win enough cash to overcome the legal costs.



And it doesn't sound like the doctor screwed up at all, if you have low bone density and that causes complications, then they might have to take an alternative route during the surgery. The fact that the doctor succeeded in spite of this issue means he performed above and beyond, not below what is expected of him.




And lastly, before you accuse the doctor of being self-interested and money-hunting, I think it's noteworthy that he's offering a large chunk of the work pro-bono because of the lack of coverage.

umm, ever heard of contingency fool?

12/27/12 10:53 PM
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Orcus Knows MMA Better Than Goku
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Orcus Knows MMA Better Than Goku - 

"Things got sketchy during the second procedure due to the density of my bones and they had to cut me open a lot more than anticipated. That's where all the blood loss and need for transfusion came in.

I was in the hospital recovering for 8 days."

 

sounds like the doctor screwed up...you may want to consider suing him...u say that the dr.'s job is to fight insurance for you...no its not...maybe hes fighting for you to deflect blame from himself

 

also u said that all the other doctors recommended a different treamtent...usually the overwhelming majority are correct..remember, he gets paid to perform on you so he is incentivized to advise you to go through surgery


all the doctors suggested a treatment that wouldn't let Conor fight ever again

Conor's surgeon went above and beyond and allowed him to step into a cage again. he advised surgery so that Conor wouldn't lose his career and would be able to fight again.

The treatment was denied because the insurance claimed the damage was due to a congenital condition. The doctor/Conor are saying that the fight caused the damage.

a doctor fights for his patient because that is his job. doctors battle with hospital administrators and insurances all the time to get their patients the best care possible.

it is posts like this that make me so jaded toward patient care. you have a surgeon who spent years and years honing his skills to be able to be good enough to do the surgery to let Conor fight again. he is successful but because insurance is trying to get off on a technicality people want to sue him.

doctors are business people just like everyone else.  dont be naive.  he is the only dr that promised him fighting again. considering the complications and the expense sounds like the dr didnt advise him correctly.  y do u think the other doctors said they couldnt make him fight again? becauae they dont like mma? because they dont like money? no. most likely because in their reasoned amd experienced judgment prrforming the covered procedures wouldnt fix him8, which as it turns out appears to be true. 

12/27/12 10:58 PM
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Smith1234
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I thought this title changed. And I also thought that was impossible. So confused. Phone Post
12/27/12 11:25 PM
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Orcus Knows MMA Better Than Goku
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aritwo - 
Orcus Knows MMA Better Than Goku - 

"Things got sketchy during the second procedure due to the density of my bones and they had to cut me open a lot more than anticipated. That's where all the blood loss and need for transfusion came in.

I was in the hospital recovering for 8 days."

 

sounds like the doctor screwed up...you may want to consider suing him...u say that the dr.'s job is to fight insurance for you...no its not...maybe hes fighting for you to deflect blame from himself

 

also u said that all the other doctors recommended a different treamtent...usually the overwhelming majority are correct..remember, he gets paid to perform on you so he is incentivized to advise you to go through surgery


all the doctors suggested a treatment that wouldn't let Conor fight ever again

Conor's surgeon went above and beyond and allowed him to step into a cage again. he advised surgery so that Conor wouldn't lose his career and would be able to fight again.

The treatment was denied because the insurance claimed the damage was due to a congenital condition. The doctor/Conor are saying that the fight caused the damage.

a doctor fights for his patient because that is his job. doctors battle with hospital administrators and insurances all the time to get their patients the best care possible.

it is posts like this that make me so jaded toward patient care. you have a surgeon who spent years and years honing his skills to be able to be good enough to do the surgery to let Conor fight again. he is successful but because insurance is trying to get off on a technicality people want to sue him.

doctors are business people just like everyone else.  dont be naive.  he is the only dr that promised him fighting again. considering the complications and the expense sounds like the dr didnt advise him correctly.  y do u think the other doctors said they couldnt make him fight again? becauae they dont like mma? because they dont like money? no. most likely because in their reasoned amd experienced judgment prrforming the covered procedures wouldnt fix him8, which as it turns out appears to be true. 

You have 40k in medical bills a year and mouths to feed yet have time to bicker online w other MMA fans but don't have money to donate to a good cause? SMH Phone Post
Yeah. It's not like anyone works 24 hours a day dummy.

Also I'm not bickering with anyone. I have conor real world solid advice.

The first piece of advice was the original title was a bad idea. He acknowled this by changing the title.

The second peice of advice was taking a second look at his doctor. Laypeople tend to view doctors as altruistic saints. They're not. I represent doctors so I know. If he is able to lower the expenses or win a malpractice case that would do a world of good relative to you basement dwelling freaks breaking your piggy banks and donating 3 dollars. Phone Post
12/27/12 11:28 PM
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Conor Heun
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First off, I'm sorry that the initial title of this thread was misleading.

Second, I am so so so grateful to by under the zuffa umbrella. They REALLY STEPPED UP FOR ME!

They paid 198k out of their pocket when the insurance company denied the claim. They are an amazing company and take amazing care of their fighters.

I had ACL surgery following my fight with Jorge Gurgel before Zuffa owned Strikeforece and we only had 50k of insurance. The bills where way over that and I was forced to claim bankruptcy to get out from under the debt.

Zuffa PAID 198K OUT OF POCKET! They didn't have to do anything. They could have stuck me with the whole bill.

They told me the final surgery wasn't going to be covered, unfortunately I wasn't in a position where I could avoid the final surgery. I had screws that had to be removed as well as the work to repair the left side.

My doctor wasn't at fault either.

He wanted to ensure that I could return to the cage to fight and he wanted his repair to last so he reinforced it.

The issue with my bones wasn't that they lacked density (haven't you seen me fight?)
It's that they where the densest bones he had ever seen, ie very hard to break or cut.

In fact, there were complications on the left side as well because the screw they were using to secure the avulsion fracture snapped off as they were putting it in because me bones are too strong.

They spent an extra hour and a half digging out the screw fragment before finding a stronger screw to use.

Hope this helps clear things up. I am very very lucky to be fighting for Zuffa and they went above and beyond the call of duty.
12/28/12 12:02 AM
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MattyECB
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Conor Heun - First off, I'm sorry that the initial title of this thread was misleading.

Second, I am so so so grateful to by under the zuffa umbrella. They REALLY STEPPED UP FOR ME!

They paid 198k out of their pocket when the insurance company denied the claim. They are an amazing company and take amazing care of their fighters.

I had ACL surgery following my fight with Jorge Gurgel before Zuffa owned Strikeforece and we only had 50k of insurance. The bills where way over that and I was forced to claim bankruptcy to get out from under the debt.

Zuffa PAID 198K OUT OF POCKET! They didn't have to do anything. They could have stuck me with the whole bill.

They told me the final surgery wasn't going to be covered, unfortunately I wasn't in a position where I could avoid the final surgery. I had screws that had to be removed as well as the work to repair the left side.

My doctor wasn't at fault either.

He wanted to ensure that I could return to the cage to fight and he wanted his repair to last so he reinforced it.

The issue with my bones wasn't that they lacked density (haven't you seen me fight?)
It's that they where the densest bones he had ever seen, ie very hard to break or cut.

In fact, there were complications on the left side as well because the screw they were using to secure the avulsion fracture snapped off as they were putting it in because me bones are too strong.

They spent an extra hour and a half digging out the screw fragment before finding a stronger screw to use.

Hope this helps clear things up. I am very very lucky to be fighting for Zuffa and they went above and beyond the call of duty.

Wait, I'm confused. You're describung osteopetrosis, opposite of osteoporosis kinda, hen your bones density is abnormally high.

That also shoukd make you susceptible to fracture... Guess they're denser than usua, but not enough to be pathological so you only benefit, current unique situation aside. Never heard of that, really interesting

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