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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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#1
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I'm wondering if anyone knows... is there a time limit on how long insurance companies can consider a newly approved device to be "experimental?"
(I feel like I should already know the answer to this, with all of the research I've done!) Thanks! Kim
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Wife of Dean, age 32. Injured 12/05- snow shoveling. Herniated Discs & DDD at L4/5 & L5/S1. -Chiropractic treatment -3 Failed injections -Orthopedic Massage Prodisc Surgery on 2/22/07 Dr. Yue Yale New Haven Hospital, CT L4/L5 & L5/S1 Back |
#2
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This is an excellent question. Does anyone have access to Westlaw to do a little legal research on this issue. I know with my denials, the problem was "no proven long term success" meaning US published studies more than 2 years...but I don't know how many years it takes before they cant make that agrument...Technically I think the FEHB (feds ins) policy is the way to argue....once it's FDA approved you cant call it experimental and investigation.
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Injured 9/01 Annular tears L4/5 & L5/S1 denied adr by insurance for 2 level charite as well as hybrid fusion at L5/S1 with Charite at L4/5. New ins paid for 2 level lumbar prodisc surgery on 4/7/08 (at age 39) with Dr. Westerlund, at Core Orthop |
#3
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My wife has access to Westlaw, what do you need to be looked up? The more info you can give me the better due to her not having alot of time right now because she is studying for the Bar exam
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Oct 2005- Repurtured L4/L5 & L5/S1 Oct 2006 -Discogram Hybrid Surgery Feb. 21, 2007 at New England Baptist Hospital in Boston Charite ADR at L4/L5 and Fusion at L5/S1 Workers Comp paid 100% Feeling Great!! Contact me with any questions either o |
#4
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Sean,
I PM'd you regarding Westlaw.
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Injured 9/01 Annular tears L4/5 & L5/S1 denied adr by insurance for 2 level charite as well as hybrid fusion at L5/S1 with Charite at L4/5. New ins paid for 2 level lumbar prodisc surgery on 4/7/08 (at age 39) with Dr. Westerlund, at Core Orthop |
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