Insurance Paid - Dr. Clavel 2 level ADR
 

Hi all,

Its wonderful to have my life back! And I am excited to report that BCBS did PAY "out of network", which is 60% of the cost of my surgery with Dr. Clavel.:clap::clap:
I honestly have no idea why or what we did any differently than anyone else. Possibly it was the documentation? or the fact that I have a Worldwide Blue rider on my policy.

We sent our documentation to Worldwide Blue the last week of Jan. 2013, by Fed EX with a signature required. We included a cover letter detailing my injury and the course of medical treatment and physical therapy that I partook in for the 3 1/2 years after the injury. In the letter we explained that the interim treatments were not working and that I along with my local neurosurgeon began looking for a solution. My Dr. Neuro's final diagnosis was for a two disc replacement (he uses the Pro-disc).
We explained that it was determined that a 2 disc replacement in a SINGLE surgery was best for my situation and that we also had determined that the M6 was best suited for me. (this was based upon our research, my Dr. had never heard of the M-6) We even stated that the M6 had not yet received FDA authorization, but was used successfully and routinely in Europe - specifically Spain- at a fraction of the cost for a single disc replacement in the USA.
We included detailed documentation of everything including a Letter of Medical Necessity from my local Neurosurgeon, copy of the auto accident report which was the cause of my neck problem, copies of paid invoices from BSC, detailed itemization of the total charges related to the surgery, proof of payment, medical reports, copies of x-rays, etc....
It also should be noted that I had 2 plus years of physical therapy, pain management, injections, chiropractor and had exhausted every conceivable alternative to surgery.

We are still in shock - can't believe that we were paid! It should be noted that it took more than 3 months for us to receive the check.

Hopefully, we will see more insurance companies pay for this in the future!

I do not know why they paid or what we did any differently from any one else who has attempted to be reimbursed by their insurance company so I really do not have answers. I will say KEEP DETAILED RECORDS OF EVERYTHING! I even requested copies of my doctor's notes for every visit (do this at the time of the visit as you check out) Also request copies of the radiologists reports for every x-ray, MRI, Myelogram, etc... I have a stack of documentation several inches thick. So keep copies of EVERYthing including hotel bills, dining, travel expenses, EVERYthing!

Hope this helps!

So happy for you!! I wish you a speedy and successful recovery. This is a very positive thing; having your insurance pay for what they are supose to!

Tammi :jacks:

Confused, I don't know what to say!?!? Congratulations!!!

That is GREAT news!

Wow, good for you! You're right in that the more receipts and documentation you have the better your chances of getting money for anything. Very hard when you are in pain though to think of everything so well done you.

My wonderful spouse deserves most of the credit! He is great at keeping records and he encouraged me to keep a diary, notes and to get documentation from the doctors. But I really believe the documentation & having it organized probably had something to do with insurance paying... On that note I got my annual increase - UGH! It goes up 15 - 20% annually since the new Health Care Bill was passed.

I had a simmular experiance with BCBS also. I submited it to Blue Card int. and it was approved and I was given 80% back in two checks fro some reason but hey its all good when you get money back and it also took about 6mo to get it. I thought for sure I wasent going to see a thing.:clap:

Good for Both of you.
 

Glad to see that BCBS is now paying, if they want to stay in business, they have to go back to the books and realize, how to make money, how to pay for the injuries and make money while doing this or get out of the business altogether.

I have three more tests to take, in the coming weeks, all of it will be documented, as is everything else, even pain medication.

Good to see that the M6 really works, M6L, I emailed someone that had one put in at the L5-S1, four years ago, it really works, recommends it.

Again,

Glad for you Folks, still amazes me, that the FDA won't approve the M6.

Jerry

first test
 

First test this Tuesday, Facet block, don't like the idea of a needle in the back, but they will numb the site first.

Probably will feel good afterward.

J

I received a letter of non-certification from the "Medical Cost Management Corporation" for BCBS. I can't believe that they won't even consider fusion. Their "Principle Reason" is that my pain should be controlled with lifestyle changes and conservative treatment. They really want you to jump through hoops. Well since I'm the queen of record keeping, they will receive a 5 page letter outlining my "conservative" treatment along with doctors notes and results for the past 5 years. THIS THEY ALREADY HAVE! For goodness sake, BCBS paid for it! I have always been a firm believer that you never give up. These organizations rely on people throwing their hands in the air and saying, "oh well." Please let me know if there is anything else I can request or document while in Germany. I don't want to leave Dr. Bierstedt's office until I have whatever documentation, coding, etc. that can at least give me some chance of reimbursement; minuscule as it may be. I am elated to hear that many of you are being reimbursed, especially for multi-level. I am hopeful too. Congratulations for breaking the boundaries so the rest of us may pass!
My sincerest gratitude :)

Herron,

Whoo Hooo!! It's great to hear that BCBS is stepping up and paying. It will be interesting to see what happens in the future as the health care bill goes into effect, I fear THE BILL will further limit and reduce the possibility of multi level ADR in the USA. Hopefully, private insurance will broaden out to include more opportunities for patients to make choices for medical treatment outside of the USA.

Congrats on your reimbursement!:clap:

Laura,

If you want to know what we sent send me a private message....:)

To Laura B

Sorry, this placed my reply at the end, I had to log in to reply.

You are going to Germany, Dr Bierstadt?
This is with the German Spine Institute, how long did it take to get a reply from them, how much information did you send them, and what did they tell you about cost?, and did they file with your insurance company?

Sorry for all the questions, I have 3 discs in particular that are bad, L5-S1 is the worst, I don't really have a disc, and this has really strained the rest of the lower back, had a blow out at L2-3, and this was cleaned up a bit, with a discectomy, but it still aches and is now compromised.

Just had an Epidural, L4-5 and L5-S1, this hurt so bad (when the fluid from the epidural hit the L5-S1), that I could not breathe for a few seconds, there is NO way, I will have a Discogram.

Not going to happen, did you have a discogram?

Again, Sorry for all the questions.

Jerry

Laura B,

I have heard of some people with international coverage saying that the surgery was done on an emergency basis and therefore BCBS or another ins. company would be responsible. It certainly seems like the insurance denials are getting overturned. They were not going to pay for my second lumbar surgery but I had primary and secondary coverage and they both paid. It is truly complicated as to who is denied and who is covered. When you see in the U.S. that the ADR surgery can be less expensive than fusion and then you add in all the problems that can happen with both but are more frequent with fusion, you see how short-sighted some of the insurance companies are.

K

Jerry: Sorry I didn't respond sooner - I've been getting my business in order for my trip. Yes, to answer your question. I'm leaving Monday 9/2 for Germany for surgery with Dr. Bierstedt on 9/9. I'm having two level ADR (M6) for C4/5 and C6/7 with a possible C3/4 - only if necessary. My cost came to 28,000 euro with an additional 3,000 euro if the 3rd level is needed. It took about a week for Dr. B. to get back with me. I sent him my MRIs and Dynamic X-Rays - along with the diagnostic report in a zip file through "dropbox." Although they have had trouble receiving in the past, for some reason it went through for me. I had originally made plans for surgery elsewhere, but after hearing from Dr. Bierstedt, his team, and the overwhelming positive responses from this forum - I'm confident that I made the right choice! I don't like discograms (in fact, I've been reading that as a diagnostic tool, it really doesn't produce the best results and can certainly cause damage to the tested level). I would only do it if absolutely necessary, but once you have heard back from Dr. Bierstedt, he will let you know if any other tests may be necessary. You can certainly PM me if you are still waiting to hear from Dr. B. - I'll assist you if I can. I can only imagine the pain you must be feeling - I certainly hope that you can get some relief very soon. This is not the way we were meant to live.

Kimmers: Thank you for the suggestion. I will try the "emergency" route as well. I'm desperate to recoup some funds back. As most of us have dipped into financials that were not designated for this type of surgery, it would certainly be a blessing to have the insurance reimburse for even a portion of it. I will keep all of you updated as I enter into the brutal battle of the ambiguous insurance dilemma.

Laura,
Do you have a worldwide rider? The worldwide rider seems to be the key to get any coverage. I do not have this and at this point am still thinking that I will not submit. My fear is that they could use to have me pay back for follow-up visits and PT saying that it is part of a illegal surgery that they did not cover. And, another payment on the surgery loan to be made tomorrow---

I am so glad that you have made a decision and wish you a safe travels tomorrow. There is an app called Pinger that allows free texting with wifi and you can make calls with wifi if you purchase minutes, about $5 for 100 minutes. Also, no English TV in Germany, you can use couchtuner to stream tv shows and movies with wifi-Rick(Gman) said this tip helped him out tremendously!

Good luck to everyone - I think it is important that we push insurance to cover the costs of ADR surgeries overseas. I do believe that we have to be our an advocates and push for reimbursements.
My surgery was reimbursed by BCBS, I might mention that we sent the claim in directly to Worldwide Blue - not sure if that helped or not, but worth a mention.
It will be interesting to see if they reimburse me anything for the recent one year follow up visit.... (which I am happy to report that I am pain free & back to doing everything I want to do!!!):jacks::clap:

This is always great news! I did submit to Blue Cross Worldwide and awaiting to hear a positive response. You are absolutely right that we need to be our own advocate and keep pushing the insurance companies to do the right thing. So far my physical therapy had been preapproved and they're picking up 90% of the cost.

TPatti - I must have missed your message before my trip - so sorry. I wish I knew about the "pinger" it would have been extremely helpful - since my kids are "BIG TEXTERS." This would definitely be a good post for the travel information thread.

Thank you and good luck to the rest of us.