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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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Hi, all --
On 5/25/07 I had 3-level ADR (ProDisc, L5/S1 - L3/4) and it was a huge success -- I feel incredible. Now I'm embroiled in the insurance battle over coverage. Despite having paid for multilevel ADR for other patients, so far Aetna refuses to pay anything. My second-level appeal is due next Tuesday, 1/15. My lawyer feels the critical piece to winning my appeal is finding precendent, so I am writing to ask anyone who has had Aetna cover multilevel ADR to please reply to this post and/or send me a PM and/or email me at elaffin@adobe.com ASAP if you are willing to speak with me. I would sincerely appreciate it. I have already searched the boards and PM'd the three members I could find who posted about Aetna covering their multilevel procedures. Many, many thanks, everyone! Eliza
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2000 DDD Jan '04 L4/5 & L5/S1 ruptures, laminectomies both levels May '05 Discogram - annular tear L3/4 - pain at all 3 levels Sept '06 L5/S1 re-ruptures, discectomy L5/S1 Nov '06 DVT & massive bilateral pulmonary emboli 3-level ProDisc (L5/S1-L |
#2
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have you been in contact with BB? if you do a "find" for aetna you'll see his post of Aetna coverage for 3 level by delamarter in '06
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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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I did, thanks. Replied to his post and sent him a PM. Thanks for the suggestion!
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2000 DDD Jan '04 L4/5 & L5/S1 ruptures, laminectomies both levels May '05 Discogram - annular tear L3/4 - pain at all 3 levels Sept '06 L5/S1 re-ruptures, discectomy L5/S1 Nov '06 DVT & massive bilateral pulmonary emboli 3-level ProDisc (L5/S1-L |
#4
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Aetna did pay for my three level surgery. However, I had an Aetna policy that allowed me to go outside Colorado. The hospital was also in the Aetna network. My surgery was approved under the label of "compassionate" surgery. I believe this was through the FDA... The first disc was approved and labeled Prodisc and the other two were off label (or something to that effect)..
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DDD for 10 Years 10/06/06: 3 Level ADR (Prodisc) Surgery,with Dr. Delamarter |
#5
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BB -
Would you be willing to discuss offline? Any examples of Aetna paying for multilevel regardless of the details of the plan under which payment was made are extremely helpful. An example of "compassionate care" would be extra helpful, actually, as that is part of the argument I am making in my appeal. If you'd be willing to help, please email me at elaffin@adobe.com. My appeal is due 1/16 but even late correspondence is generally accepted and may help. I would deeply appreciate it if you'd be willing to talk. Thank you! Eliza
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2000 DDD Jan '04 L4/5 & L5/S1 ruptures, laminectomies both levels May '05 Discogram - annular tear L3/4 - pain at all 3 levels Sept '06 L5/S1 re-ruptures, discectomy L5/S1 Nov '06 DVT & massive bilateral pulmonary emboli 3-level ProDisc (L5/S1-L |
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