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Insurance Hell All insurance-related matters are here: Medicare, worker's compensation, appeals, denials, insights, wins, losses. PRICING is here too. Note: This forum has posts from 2006 forward. Older ones are in the Big File. |
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#11
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Hi RP,
Thanks for all of the information and good luck with your efforts! I'm just now starting the process and haven't even tried submitting anything to UHC, but based on my research I think it's certain that I'll be rejected unless I accept fusion as a treatment. My back has gotten significantly worse over the last month so I've started moving from just doing research to scheduling appointments, etc. I expect to start having to deal with UHC very soon (one I get a recommendation from the doctor). I'd appreciate any recommendations or information that you may have to help with this process. |
#12
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Quote:
Next time you try to get a health insurance company to cover any kind of modern medicine, be prepared for them to consult the oldest living doctor in the world. I mean seriously I know I'm only 30 and maybe look like I'm 24 but come one a pediatrician???????? anyone else have UHC give them a doctor that has NOTHING to do with their case?
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Becky (30 yrs old) From Wisconsin. 2004 my back goes out for the first time. MRI in 2004, 2009 & 2011 DDD L4-L5. MRI in 2011 more DDD and disc starting to bulge. Fought UHC for 8 months and WON October 31, 2011 IRO overturned UHC denial! November 22, 2011 my spine got an upgrade. (ProDisc-L) Best medical decision I have ever made http://www.facebook.com/rebeccabille my story: http://youtu.be/hT1jKmcOV8Y |
#13
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ProdiscL FDA weblinks v. AxioMed FLD/ALIF fusion.
Just wanted to update anyone interested in the ProDiscL study which started back in 2006 and should be concluding shortly.
PRODISC®-L Total Disc Replacement - P050010 Links on this FDA page show labeling has been accomplished and further data should be forthcoming this year. I've applied for an Axiomed FLD study and was denied, however, that study used ALIF fusion as the baseline verse Synthes ProdiscL, so it was risky if one didn't want fusion. I didn't feel a great loss to that. Many studies, still open, use ALIF fusion against either the ProdiscL or FLD: Please read the FDA study details before considering any of these procedures. Currently, Axiomed has several ADR study locations where the candidate gets either; the Axiomed FLD or/v. ProdiscL. Note that in these studies the ProDiscL is now the baseline - not fusion - as used prior, circa 2006. My neurosurgeon from Rush University Hospital in Chicago says that the ADR proceedures are about 10% better than ALIF fusions from his interpretation of early data and personal surgical experience. So, after six (6) years we're looking at 60 - 80% satisfaction rates, which are higher than the 50 - 70% with ALIF fusion. I've been in multiple Workman's Compensation Hearings in Illinois over this fight for ADR. My WC carrier is Travelers, but my private carrier is UHC up in Wisconsin where I live. The hospital prefers using WC payments because they pay a greater percentage than the typical 50% or less of today's private criminal carriers, i.e. UHC. Should I not get approved in ILWC (Travelers) hearings or continued attempted appeals with UHC, I shall work harder to enter one of these ongoing studies with disc verses disc. BTW, I'm also challenging UHC for specific medication coverage denials; which they covered last year but have started denying this year: All things being equal except on their end. Seems, I'm spending more time in hearings or collecting data in prep for hearings for numerous items these days. I just hope there are still a few humans to act as judge - not just the usual pro-corporate owned actors many of us have seen. Anybody from New Zealand in this forum? I'm wondering how progressive Countries deal with medicine?
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DDD, L5-L6 (yes, L6!), L6-S1 naturally fusing, ILWC L5-L6 ALIF recommended - not acceptable , my Neurosurgeon ordered ProDiscL ADR 6-2010, still fighting ILWC for ordered ADR treatment. |
#14
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Finally approved!
I have UHC and have been fighting with them since April 2011 and as of October 31, 2011 an independent review company (MCMC LLC) reviewed my claim to approve ADR and my request has been approved!
So it is possible to fight UHC and WIN!!!
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Becky (30 yrs old) From Wisconsin. 2004 my back goes out for the first time. MRI in 2004, 2009 & 2011 DDD L4-L5. MRI in 2011 more DDD and disc starting to bulge. Fought UHC for 8 months and WON October 31, 2011 IRO overturned UHC denial! November 22, 2011 my spine got an upgrade. (ProDisc-L) Best medical decision I have ever made http://www.facebook.com/rebeccabille my story: http://youtu.be/hT1jKmcOV8Y |
#15
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Hey, congratulations gymnast1981! It's so great to hear success stories; especially with insurance companies. The struggle you went through will make it easier for those who try later. Thanks!
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Applied for S.S.D.I./Medicare, 1st appeal. Dr. ordered Discogram of S1/L5, L5/L4, and L4/L3. Have not gotten; 2 lower discs black/herniated Injections in cervical, thoracic, lumbar, and 8+ in S.I. joint Plan: Trying to see spine surgeon at charity hospital, further diagnosis. Evaluate for S.I. joint fusion and lumbar and cervical fusions/ADR. |
#16
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Congratulations! and can we get an Amen!
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L5-S1 Lumbar M6 by Nick Boeree 10-14-2011 |
#17
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Congratulations!!
and can we get an Amen!
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L5-S1 Lumbar M6 by Nick Boeree 10-14-2011 |
#18
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Aaammmeeennn!!!
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Applied for S.S.D.I./Medicare, 1st appeal. Dr. ordered Discogram of S1/L5, L5/L4, and L4/L3. Have not gotten; 2 lower discs black/herniated Injections in cervical, thoracic, lumbar, and 8+ in S.I. joint Plan: Trying to see spine surgeon at charity hospital, further diagnosis. Evaluate for S.I. joint fusion and lumbar and cervical fusions/ADR. |
#19
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update
Ok so I said that my surgery for ADR is Nov 29... Doctors office called to reschedule it... now its November 22. Im kind of freaking now!!! nervous and yet excited!
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Becky (30 yrs old) From Wisconsin. 2004 my back goes out for the first time. MRI in 2004, 2009 & 2011 DDD L4-L5. MRI in 2011 more DDD and disc starting to bulge. Fought UHC for 8 months and WON October 31, 2011 IRO overturned UHC denial! November 22, 2011 my spine got an upgrade. (ProDisc-L) Best medical decision I have ever made http://www.facebook.com/rebeccabille my story: http://youtu.be/hT1jKmcOV8Y |
#20
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Best of luck!
and Congrats on getting the approval from UHC!
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12/2008 early am gym class-something very wrong 2/2009 DDD 4 herniated cervical discs 3/3009-8/2009 8 spinal epidurals, pt 09/2009 C6/7 Prodisc C ADR 11/2010 facet joint inj 12/2010 Rhizotomy TBI Dr. Cottingham months of relief 05/2011 facet Joint Inj 06/2011 Rhizotomy 7/2011 Dr. Zigler TBI, facet block and Discogram 11/18 surgery with Dr/Mr. Boeree..Thank God. |
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