Letter of Medical Necessity

[brokenbrian]

I need to submit one of these to my ins company. I have seen a few surgeons in the past fews months and all of them want me to do another micro discetomy or fusion. I cant seem to find anyone here in Minnesota that will even give me the option of ADR. I can have my Chiro Dr write one for me, although I dont know if that would even help me or not.

I have done some research and I would like to talk with Dr Nick Boeree. Has anyone contacted a Dr overseas and had them write this letter for them? I cant keep going door to door here in MN until I find someone. Or does anyone know any ADR friendly Drs in Minnesota? Lol Im having alot of trouble and I havent even started yet.

Any input will be appreciated.

Thanks

Brian

[Jstuckey]

I would guess that any physician outside of the US will have no willingness to write, nor any credibility with your insurance, regarding medical necessity. That's a creative thought though!

[Jstuckey]

I'd find the doctor first who's opinion you agree with, then have them do the necessary work to your insurance. Sorry, don't know anything about Minnesota doctors. There are several US physicians that seem to do a good job from comments on this site - if you're willing to travel outside of Minnesota.

[brokenbrian]

I was afraid that might be the case. Funds are alittle too low to travel out of state to get the letter, just to have the insurance deny it and start back at square one. I guess i'll have to have my chiro Dr write the letter for me and hope the insurance company doesn't laugh at me. I really need to find someone here that does or will reffer and ADR. I just didnt think it was gonna be so hard to find someone in the twin cities.

thanks for the info

[Jstuckey]

You may get other info... I'm no expert.
I just got three (4th is probably in the mailbox) denials from the insurance precertification process, so I feel for you. I was just told this morning that even if it was approved, if I want another opinion or a different surgeon, it starts all over from square one with pre-certification again. That's just my insurance though... they are all so different. You might actually even call your insurance and ask for suggestions on the best route to take. Wouldn't hurt.

[brokenbrian]

Yea thats a good idea. Maybe Ill get lucky and someone will be able to give me more info than the last person I talked to. Too bad it has to work out this way. If all they care about it money then you would think it would be much easier to get an ADR. Just tell the insurance company....Fusion $100,000 and ADR $45,000 which one you wanna pay for?

[annapurna]

Originally Posted by Jstuckey

I would guess that any physician outside of the US will have no willingness to write, nor any credibility with your insurance, regarding medical necessity. That's a creative thought though!

Actually, our experience is that you'll spend an inordiante amount of time educating a foreign surgeon as to what is needed and why but they'd write one for you once they understand what is necessary. The problem is that many insurance companies will demand a letter written by a doc that they can call, effectively a US surgeon or nothing.

[brokenbrian]

Originally Posted by annapurna

Actually, our experience is that you'll spend an inordiante amount of time educating a foreign surgeon as to what is needed and why but they'd write one for you once they understand what is necessary. The problem is that many insurance companies will demand a letter written by a doc that they can call, effectively a US surgeon or nothing.

Well that raises another question. I actually did find a small independent clinic here in MN that does offer ADR. (and if anyone is curious pm me I have the link) Now I could go visit them and I'm sure I could get them to write this letter. But if that happens will I end up having to get the surgery with them, if its approved? Or (fingers crossed) could I take my approval and then head overseas to have an experienced surgeon preform the surgery?

Brian

[Jstuckey]

You'd have to check with your insurance, but I would think that would be rare. My personal insurance says a precertification is for that surgeon and that procedure only. Any other doctor or procedure starts the process all over again. But there is no set standard. I think insurance companies can do what they want. I've seen posts by others that had their US insurance companies reimburse for oversees ADR surgery. THAT is good insurance, which I obviously don't have. Keep searching! Read the insurance warrior thread. It might give you ideas.

[kennethhoff]

Does your insurance company require you to see a surgeon in Minnesota? Are you able to see someone outside your state? If so, I'd call the Texas Back Institute and ask for Dr Richard Guyer and ask for his suggestions. I'll bet he would recommend one close to you, maybe even in your state, who is very good (Dr Guyer is one of the best in U.S.) (1-800-247-2225)

Here is also a link to the "Top 50 Spine Docs in America":
50 of the Best Spine Specialists in America

Ken

Originally Posted by brokenbrian

I need to submit one of these to my ins company. I have seen a few surgeons in the past fews months and all of them want me to do another micro discetomy or fusion. I cant seem to find anyone here in Minnesota that will even give me the option of ADR. I can have my Chiro Dr write one for me, although I dont know if that would even help me or not.

I have done some research and I would like to talk with Dr Nick Boeree. Has anyone contacted a Dr overseas and had them write this letter for them? I cant keep going door to door here in MN until I find someone. Or does anyone know any ADR friendly Drs in Minnesota? Lol Im having alot of trouble and I havent even started yet.

Any input will be appreciated.

Thanks

Brian