ADRSupport Community  

Go Back   ADRSupport Community > General Discussion > Insurance Hell

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.


Reply
 
Thread Tools
  #1  
Old 12-03-2009, 08:51 PM
staci70 staci70 is offline
Junior Member
 
Join Date: Nov 2009
Posts: 11
Default Possible Blue Cross Blue Shield of Florida payment?

I apologize for the partial cross-posting from the Outcome forum. Here is our current insurance status:

We are currently appealing with Blue Cross Blue Shield of Florida. I've been watching the website, and noticed a change on 12/1.

Bills:

Surgeon (Discounted): $4,573.90
Hospital: $47,851.47 (see below. Note that this includes the $21k+ for the implant)

So, the incredible news is that BCBSFL seems to have paid the hospital bill. I've been checking their online account management every day, and it has been showing "Denied" for the Surgeon's bill (which is under appeal), but "In process" for the hospital bill. As of tonight, it shows:

Amount Billed: $47,851.47
Amount Allowed: $38,841.18
Amount Paid: $38,370.99
You Owe: $1,115.32 (Don't know where this comes from)

We are pretty ecstatic! Do I have to worry that they might change their minds?

Under "Description of Service", it says "Not Available". Is it possible that they don't realize it's related to the ADR?

(Mr. Staci70)
__________________
"Staci70"
Airline injury 7/13/2009
C6-C7 Herniation w/ annular tear
C6-C7 ADR Prodisc-C on 11/07/2009
Reply With Quote
  #2  
Old 01-03-2010, 09:42 PM
staci70 staci70 is offline
Junior Member
 
Join Date: Nov 2009
Posts: 11
Default

Surgeon has now been paid.
__________________
"Staci70"
Airline injury 7/13/2009
C6-C7 Herniation w/ annular tear
C6-C7 ADR Prodisc-C on 11/07/2009
Reply With Quote
  #3  
Old 05-13-2010, 12:12 PM
DaddyO DaddyO is offline
Junior Member
 
Join Date: Oct 2009
Posts: 20
Default

Thanks for sharing. I live in Florida and my surgeons office has said BCBS most likely will not cover it. They are still trying to see if they will though. I'm praying.
Where did you have your surgery? What surgeon? My surgeon here is planning to send me to Denver.
__________________
39yr old
Dealing with back pain 3yrs now
Been through 6 facet injections
3 Epidural injections
Discogram (If U R thinking about a discogram PLEASE RESEARCH, In my case it helped but it is very, very, painful and in most cases its not needed)
2 "tears" in disc at L3-L4 (leaking fluid onto nerves)
July 27, 2010 got Nuvasive XLTDR
Reply With Quote
  #4  
Old 05-20-2010, 01:42 AM
wgnmn wgnmn is offline
Junior Member
 
Join Date: May 2010
Posts: 7
Default

My Dr. went to bat for me for a 2 level cervical adr and was of course denied. He explained to me that since the Health-care Bill was shoved through, Ins.'s are denying as much as they can. They don't want to pay for anything unless they think its absolutely necessary. So everything is going to be in limbo until 2014.Many of the Dr.s are in agreement he said, that the way the bill stands, many Practitioners will have their income cut in half and have to lay off 50% of staff. Some are seriously considering giving up their practice. See how long you'll have to wait for answers, appointments and procedures then. The Specialists alike are kind of freaking out he said and really ticked off. I watched on CSPAN when the Senate voted on the bill. Unbelievable is all I'll say.
I am also praying for Gods answer to how I'm going to finance this. It has to be done soon, I can't work anymore and I have a lot of work lined up.
Reply With Quote
  #5  
Old 05-24-2010, 08:31 PM
Ramen Ramen is offline
Junior Member
 
Join Date: May 2010
Posts: 2
Default

Thanks for sharing. I also have BCBSFL and I was told by my surgery scheduler last week at the doc's office that they still consider it "experimental" and asked if I wanted to switch to fusion. I said fight it.

Still playing the waiting game.
Reply With Quote
  #6  
Old 07-09-2010, 02:46 AM
Lauren Lauren is offline
Junior Member
 
Join Date: Dec 2009
Posts: 11
Default Need names and permission to use for my appeal

Hi Staci - I am appealing to my insurance for the 2nd time. I am seeking the names of people who have been paid for ADR, their surgery date, surgery location, physicians name and insurance name. Would you mind providing that information? I'm building a list to prove to my insurance that ADR is becoming a standard medical practice. Since the FDA does not approve surgical procedures but rather the tools that are used in surgeries, I am appealing on the grounds that this is not "experimental". Providing precedent set by other insurance companies will help my case. I imagine that any one of us having to appeal a denied claim could use the same information. Could we build a list that lives here on the ADR site? I know I'd be happy to add my name to it, once I've been paid.
Thanks for your help!
Lauren
PS If you email me privately, I'm happy to provide any further info you might want. lauren@workinggreen.org
Thanks again.
__________________
Lauren
57yo Female Cervical stenosis with myelopathy
Fusion 2006 C5/6 to address worst of 4 levels
Fall 2009 return of symptoms
Jan 29 2010: 3 level ADR in Bogen Germany by Dr. Bertagnoli -C3/4, C4/5, C6/7 with hardware removal
Reply With Quote
Reply

Bookmarks

Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off


Similar Threads
Thread Thread Starter Forum Replies Last Post
Blue Cross Blue Shield ADR Denial finally reversed ZorroSF Insurance Hell 17 01-30-2014 06:46 PM
Blue Cross Blue Shield {aka Blue Crap} chasswen Insurance Hell 16 06-06-2012 05:03 PM
Blue Cross Blue Shield ADR Coverage stuschulz Insurance Hell 10 09-24-2007 09:54 AM
Technology Evaluation Center Blue Cross Blue Shield Abbe Insurance Hell 2 07-03-2007 07:30 PM
3rd Appeal with Blue Cross Blue Shield cavalier The Big File 10 03-25-2005 10:24 AM


All times are GMT -4. The time now is 10:00 AM.


© Copyright 2006-2017 ADRSupport.org All rights reserved.