ProDisc ADR, L4/5, NEED YOUR HELP

[kimmers]

Hello Everyone,

I need help with Blue Cross. My name is Kim and I am trying to get surgery on March 11, tuesday, approved and paid for by Blue Cross.
They have denied me but the California Nurses association (CNA) has launched an internet phone-in campaign to help me get the surgery covered. Go to http//www.calnurses.org and under media center and you will see the press release, CNA released nationally today.

Please call the numbers below. My hope is this will help everyone trying to get an ADR surgery that insurance denies. Please spread the word. My e-mail is trackgirlnut@yahoo.com if you have any questions.

Kimmers

Numbers to call to reach Blue Cross:

(818)-234-6063--Yvette Ambeguia, case manager
(312)-297-6000--Corporate Blue Cross

Web Fax:
Blue Cross of California
(818) 234-1089
National Corporate Office
(312) 297-6609

[Harrison]

Wow, Kimmers....good moving and shaking! I called and left a message for Yvette! It's interesting...BCBS California has approved many cases of ADR for patients in California....why not YOU!?

http://www.calnurses.org/

[Harrison]

Great job Kimmers -- I was notified of this story hitting PR Newswire! See here for the press release.

[JL]

HI Kim,
I left a message for Yvettee at BCBS CA that ADR has work for many and how many have got their lives back, and you deserve no less a chance. I also shared your determination to get well because when it came down to the wire after my denials by CT Workers Compensation, I realized no one was going to help and I paid cash (mostly, but Yale University (not the hospital) was gracious to finance a little). Yes it is a big chunk of change but my second to last payment just went in the mail. So even that ends. I put in a day today like I did in my 20's. Good luck. Bill

[kimmers]

Thanks Bill,

The case is out of Yvette's hands now, Ron McGillis, Blue Cross Director of Grievance and Appeals in California, now has it. He can be reached at (818) 234-2345. I need as many as people as possible to phone, fax, Blue Cross. I have to get approved. Surgery is Tuesday, March 11. Please go to http//www.calnurses.org for more phone numbers and info.

Kimmers

[Harrison]

Kim,

Can you be more specific about what our message could be to Ron McGillis? What points need to be addressed? We want to help; but specificity/brevity may be constructive?

[phylly]

GREAT JOB KIM,
I will call in the am. I would love to do the same even though I am done (I also have BC), so I hope you get this!
Phylly

[Harrison]

Wow, that's some moving & shaking!
_________________________

Monday, March 10, 2008
Small group protests outside of Blue Cross office
A Dana Point nurse is seeking coverage for a procedure that is classified as 'experimental.'
By JULIE ANNE INES
THE ORANGE COUNTY REGISTER

COSTA MESA – For Dana Point resident Kim Kutcher, even lifting her 33-pound three-year-old son is a painful experience.

The 46-year-old registered nurse has degenerative disc disease, and she said that the pain is magnified by the denial of Blue Cross of California for a procedure that would use an artificial disc to address her problem.

Kutcher, a small group of supporters from the California Nurses Association, and three of her children protested outside a BlueCross office in Costa Mesa early Monday afternoon, demanding that BlueCross hear Kutcher's case.

Rather than have the spinal fusion treatment that BlueCross suggested, Kutcher has been asking for the past four months that the company cover her for the newer treatment.

According to a statement issued by Blue Cross, the artificial disc replacement is classified as experimental by medical experts. The company had recommended that Kutcher get the more common spinal fusion treatment.

Kutcher said that the spinal fusion treatment wouldn't allow her the mobility needed in her daily nursing job.

The FDA approved the procedure in 2006 for patients under some specific circumstances, but Blue Cross is waiting for the results of a study to ensure that the care for their members "ensures quality outcomes," according to the statement.

BlueCross representative Peggy Hinz said that Kutcher's case is under independent review by the Department of Managed Healthcare.

Kutcher will undergo the artificial disc treatment Tuesday morning at Mission Hospital in Mission Viejo, paying for the estimated $50,000-plus procedure out-of-pocket.

Contact the writer: jines@ocregister.com or 714-4445-6604

http://www.ocregister.com/news/kutcher-treatment-bluecr...1996304-disc-spinal#

[kimmers]

Harrison,

It is just the start. I have to keep pushing. If you call, fax or write people, please contact Ron McGinnis, head of Grievances and Appeals and/or corporate Blue Cross, Peggy Hinz or anyone. People calling to cancel their policies I think is especially good.Pls conduct yourselves in a professional manner (not that you wouldn't but Peggy told me (wed. 19th) she has had people being beligerant to her, i told her that my friends and aqcuaintances are professional and conduct themselves so) , I still have an effective HIPPA release that allows you to ask for info about my case and speak about it.
I can tell you we do not have the money for this surgery and need to get it approved by Blue Cross.
Got home on Thursday from hospital. (3-20)
\
thank you,

kim

[Harrison]

Thx Kim for the update. Sorry to state the obvious, members, but Kim's campaign is her effort to win coverage. If you contact BCBS, please be polite and to the point (see earlier posts).

Kim, what was the outcome of the press activities? Radio broadcast?