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| Insurance Hell This is where any insurance-related matters are found. Medicare, worker's compensation, appeals, denials are here. Questions, comments, insights, wins and losses on any insurance are all here! Note: This is a new forum and includes posts for 2007 only. Older ones are in the Big File. |
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#1
06-24-2008, 01:52 AM
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I am scheduled for a single level Prestige ADR in a couple of days. I have been refused by BC/BS of Oregon for the device, but they will cover the procedure. Has anyone had any luck appealing with them? Or do you know if I am out of luck appealing if I pay for the surgery and try to get reimbursed?
Thanx for any advice!
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Single level C6-C7, Prestige ADR @ Mayo Clinic 27 June 2008 
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#2
06-24-2008, 10:57 AM
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Billy,
There are several people that have had BC/BS pay for there surgery. But, each case is different and each BC/BS seems to have a different attitude about covering ADR. I have switched to BC/BS this year, because I knew there was no way in hell UHC would cover it but they might. Hopefully you'll get some good responses soon. Keep on searching the archives here and you should be able to PM a few memembers about their insurance battles. Don
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3 level DDD L5-S1 through L3-L4. "Compressed" L5-S1 in ~1992. Herniation at L3-L4 and L4-L5 Fusion or ADR in near future
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#3
06-24-2008, 12:11 PM
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I've had BC/BS Michigan cover my 4 level ADR surgery done at Stenum Hospital in Germany. I am 1 year 8 months out from surgery and bicycling like a maniac and loving/living life.
Best of luck to you. Terry Newton
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1980 ruptured L4-L5 1988 ruptured SI-L5 1990 ruptured C5-C6 1994 ruptured C6-C7 1995 Hemi-Laminectomy C5-C6, C6-C7 Mayo Clinic Bicycle Accident 2004 MRI, EMG, Facet Injections, Epidural Blocks, Lumbar Discogram. Stenum Hospital Surgery November 4, 2006 Prestige Disc C5-C6, C6-C7 Maverick Disc S1-L5, L4-L5
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#4
06-24-2008, 05:28 PM
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BCBS of Mass. reimbursed me for my ADR, in December of 2004! Sure, I was tenacious, creative and pulled every lever I could. It worked!
I haven't decided yet if I can or will offer appeal support directly patients. Gosh, we know it is needed! What a sad situation for all of us.
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"Harrison" info (at) adrsupport.org Founder & Moderator of ADRSupport & APF Arthroplasty Patient Foundation, a 501 (c)(3) Reborn June 25th, 2004, L5-S1 ADR Charite in Boston Fell on my ***winter 2003, Canceled fusion April 6 2004 Cell: 617-314-5900
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#5
06-25-2008, 10:46 AM
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Thanx guys! What's sad is that in the long run it is less expensive for the insurance company and disability. 48 hours to go! Talk to you all on the other side.
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Single level C6-C7, Prestige ADR @ Mayo Clinic 27 June 2008
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#6
06-25-2008, 02:20 PM
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Billy B - all the best to you! Please let us know how it goes!
Best wishes and prayers for your recovery. Lisa
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Aug 2007 - diagnosed with DDD at C5-6 - herniated disk with mild stenosis at right/central of cord - but pain/occasional numbness mostly on the left side - and down into the leg/foot - which has puzzled doctors - even had a lumbar puncture - but thankfully all clear! May 2008- after many months of no symptoms and issues- flare up- and new MRI shows moderate stenosis. L4-5 small annular tear with some DD Big fan of massages and acupuncture to help with muscle tightness/pain.
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