Ok, another update. 2nd appeal denied. The reviewer, who claims to be a doctor, said that the surgery would be part of a clinical trial and therefore is experimental/investigational. What a cluebag. The prestige disc has been approved for nearly 1.5 years and they think because my Dr's notes show that we discussed the options of adr AND fusion that it MUST be part of a clinical study. He even stated that it was a fact. Guess it was too much trouble to pick up the phone and ask my Dr.

It would be funny if it wasn't so important to me to get the adr. The basic lack of understanding regarding the procedure astounds me. I've already filed a complaint today with my insurance company. Hopefully it will get some traction.

Jason,

My wife was given verbal approval for either fusion or ADR. She has BCBS but is also on my Aetna policy. I'm not sure how they're splitting the bill but it sounded to me like an approval. She's opted for fusion on the 26th.

Bob

I wouldn't count on a verbal approval, get it in writing.

Another update
 

I called my doc's nurse again this morning to see if they had heard anything. She called back just as I was leaving work with some hopefully good news.

After the first appeal denial and asked my HR department if they could assist with the insurance company as we're self insured. They agreed to ask some questions, especially wanting information on why the specific procedure was denied since it was FDA approved, cost about the same, and was preferred by both myself and my Dr. I made sure my HR rep was informed of my opinions and beliefs on the reasoning of the insurance company for denial. The insurance company kept denying based on either long term safety and efficacy or by claiming it was investigational.experimental. The last denial even claimed that I HAD to be part of clinical study.

The Dr's liaison with the insurance companies called my insurance company today to get an update and was told by the insurance company rep that my company had gotten involved and the denial would likely be overturned. Far from being written in stone but the nurse sure was excited. Hopefully I'll hear something in the next few days.

Good luck, I hope you are able to get your surgery soon. The waiting is so agonizing.