Exciting News in Insurance Developing

[Harrison]

Folks, you may see the articles I frequently post (almost daily) in the article library -- most are specific to ADR. Today's post about patients in NJ hints at BCBS policy changes for ADR coverage in the near future!

Also, one of our members had a huge real success appealing & winning against Athena's policy of not covering ADR -- she won and she's covered! More on this from her soon...

[NCFUSED]

I have my fingers crossed the UHC is moving in this direction also.....

John

[MAX]

I tried to make my case with my insurer last November after FDA approval. Said they would consult Orthos for review. I never got a call back, so just before Christmas I called...

Told to wait "Too new - don't be the first one.."

I am so frustrated I can't stand it.

Max

[Harrison]

Max, I would be even more frustrated after getting that response! Did you get a copy of their policy that states the nature of their exceptions for coverage? Most or many insurers call ADR "experimental," which is no longer the case -- at least with the lumbar arthroplasty.

More soon...

[Breia]

Originally posted by Harrison:
[qb] Folks, you may see the articles I frequently post (almost daily) in the article library -- most are specific to ADR. Today's post about patients in NJ hints at BCBS policy changes for ADR coverage in the near future!

Also, one of our members had a huge real success appealing & winning against Athena's policy of not covering ADR -- she won and she's covered! More on this from her soon...

[/qb]

FYI: When I had my surgery 13 months ago, my insurance carrier paid for everything with the exception, of course, of the deductibles which I had already met. When I confronted the person in the insurance position at the hospital where I had the surgery, she indicated that it did not matter which procedure I had, the insurance would pay anyway (I am in a study and could have drawn a fusion or the ADR). I was horrified that my carrier would not pay, but they did with no questions asked. I was fortunate in that a number of patients have paid for their ADRs out-of-pocket. I live in Georgia and the little college where I am employed provides pretty good coverage for us. It helps when you are in a group policy.

BTW, good morning everyone. Hope this finds you all pain free.