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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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#21
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Well I'm about to open up a can of whoop-arse on Liberty Mutual. I hope to do it without a lawyer. I'll keep you posted.
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12/16/03 Work Accident Herniation and DDD at L4-L5 4/1/05 Discectomy Epidurals and facet injections 5/15/06 Discogram confirmed L4-L5 DDD also an asymptomatic L5-S1 tear 10/24/06 L4-L5 Prodisc surgery with Dr. Goldstein CAT scans & X-Rays show ossification Trigger Point Injections, Medial Branch Blocks, Acupuncture, Weekly Deep Tissue Massage 10/27/08 Discogram (positive L5-S1 tear) 11/25/08 L5-S1 fusion with Dr. Goldstein FAILED BACK SYNDROME Liberty Mutual WC |
#22
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Hi Laura,
I just got 2nd denial from Motion Picture Blue Cross. I would love to know how you got approved. I am looking at L3 L4 Prodisc replacement. Any help would be great! Thanks, Abbe
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Water ski accident 86' Chiropractic& PT Pain meds Discectomy Laminectomy L5 S1 Partially sacralized 97' epidural injections L3 L4 ruptured and torn L4 L5 Almost no disk height left along with osteophytes Left leg pain and tingling going down back of leg into heel & foot 3 appeals with BCBS no success Lost insurance. Kaiser Permanente L3-L4, L4-L5 Prodisc 9/18/09 C5-6 & C6-7 ruptured and looking at hybrid surgery fusion & Prestige ADR |
#23
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Hi, I'd love to see the letter granting your successful appeal. I'm in the process of trying to get Aetna to approve a 2 level ADR at L4-L5 and L5-S1. I've been somewhat successful, I did receive approval for a 1-level ADR and the other for fusion, but from what I've read I think I'd be better off with 2 ADRs. Please email me at dgasgari@gci.net any information you think would be useful for my appeal. Thank you so very much!
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#24
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I am putting together a packet and will be very happy to share with any interested. I am working to get a second Prodisc from Blue XS. I will keep you posted.
Harrison, I am SORRY iwas an idiot and idn't see the links before. Please accept my apology. Meg
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Meg Herniated Fragmented Disc L3-L4 with L3/L4 nerve root compression 2002 Far Lateral discectomy 2002 Prodisc Implantation L3-L4 2004 Multilevel DDD Planning for L5-S1 Prodisc soon Past Hoops player, surfer, left wing hockey player. CUrrently |
#25
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Meg, no problem. There's too much information here for anyone; it is a challenge to organize. Good luck with all, and pls keep us apprised...
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"Harrison" - info (at) adrsupport.org Fell on my ***winter 2003, Canceled fusion April 6 2004 Reborn June 25th, 2004, L5-S1 ADR Charite in Boston Founder & moderator of ADRSupport - 2004 Founder Arthroplasty Patient Foundation a 501(c)(3) - 2006 Creator & producer, Why Am I Still Sick? - 2012 Donate www.arthropatient.org/about/donate |
#26
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motorman,
I am concerned that you are having problems getting 2 levels of ADR approved???? Everyone on here before seemed to have no trouble with multi levels with ADR. Why would Aenta approve 2 level Charite eaiser than 2 level ProDisc? Or are they tighening up on their approvals???? Anyone know more?
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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 |
#27
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I am sorry that I a have been away for so long. I will find the papers that will be important for an appeal and any info showing that the insurance covered it should help too. Anyone still wanting this info, could you please email me? Thanks!!!!
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Laura Missing Facet Joint L5-S1 Collapsed Disc L4-5 DDD L3-4 Severe Stenosis Disco + 3 levels Sched. Oct. 11 - 2 level ADR & fusion Dr. John Regan - L.A. Awaiting approval! [URL=http://www.lauracedar.com/XrayGallery]www.lauracedar.com/XrayGallery[/U |
#28
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Laura,
I am gathering info for my 33 year old son, who has Empire BC/BS thru IATSE (International Actors Theatrical Stage Employees). since this union is in CA, I am hoping to have some sucess (my son lives in NY). My son needs a two level L4-L5 and L5-S1 (probably ProDisc). At this point the plan is to go to Germany but that might change if we could get paid in the US. Any info you can provide would be helpful (your approach and timing). |
#29
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Hello Laura,
congratulations on your approval. I would also like the information on your appeal. I also have BC and was denied. I have BS as my primary and they denied me first the BC. I appealed to the IMR. I was denied again. I will still appeal although I already had the surgery by Dr. Delamarter and was a cash pay. I am so happy for you. I hope you do really well with your surgery. Keep us posted. this gives me some hope. Thanks for the info. Phylly
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Cervical fusion C4-C6 2002 Fall on tailbone April 2005 Discogram concordant at L4-S1 2007 for back pain not leg pain Prodisc ADR surgery L4-L5-S1 November 2007 Decompression surgery L4-S1 for left sided sciatica July 2008 Continued back and leg pain, looking at possible fusion Removal of Prodiscs and L4-S1 fusion February 2009 |
#30
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Laura,
Please swend you email again I could not pull up you URL. I would love the info on your approval I am still woking on getting it retro approved and any thing you did would be very helpful. Thanks so much, Phylly
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Cervical fusion C4-C6 2002 Fall on tailbone April 2005 Discogram concordant at L4-S1 2007 for back pain not leg pain Prodisc ADR surgery L4-L5-S1 November 2007 Decompression surgery L4-S1 for left sided sciatica July 2008 Continued back and leg pain, looking at possible fusion Removal of Prodiscs and L4-S1 fusion February 2009 |
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