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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
10-24-2011, 03:54 PM
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UHC Changes Policy?
I've been recommended to have a cervical discectomy and fusion, and was considering asking for ADR, instead. When I started looking into whether United would cover it, I came across this recently updated policy document.
"Cervical artificial total disc replacement is proven for the treatment of single levelCan I assume this is a massive change in standpoint from before? 
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#2
01-22-2012, 08:33 PM
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 It sure is. Before last October, they did not cover cervical or lumbar ADR. Somewhere around Oct 5, I was calling my doctor to tell them that ADR was a sudden new option for me.
__________________
April '98 - Injured @ work Oct '98 - Declared "permanent and stationary" by workers' comp docs 10 years of PT and chiropractic... Oct '08 - Sudden incapacitating lumbar / sciatic pain with foot drop April '09 - L5-S1 microdiscectomy fixes foot drop and most of the pain May '11 Hey doc, I'm tired of my neck hurting... Dec '11 - C5-6 Prodisc-C July '12 - Neck is still doing well. L5-S1 is "done" - bone on bone July '13 - L4-L5-S1 TLIF Aug '13 - C7-T1 microdiskectomy
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#3
03-12-2012, 11:16 AM
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UHC policy
Link/study from UHC dated Oct 2011 that explains their position,
"Cervical artificial total disc replacement is proven for the treatment of single level degenerative disc disease in skeletally mature patients when used with FDA approved implants" "Cervical artificial total disc replacement is unproven for the treatment of multiple level degenerative disc disease in skeletally mature patients." "Lumbar artificial total disc replacement is unproven for the treatment of single or multiple level degenerative disc disease in skeletally mature patients." https://www.unitedhealthcareonline.c..._the_Spine.pdf
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Back discomfort started in mid-twenties. '91 - First back pain ‘episode’ 4/10 S1/L5 and L5/L4 hernias 5/11 S1/L5 rupture 1/12 L5/L4 rupture 2 level M6-L by Dr. Clavel via Healthbase on 4/18/2012
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#4
07-20-2013, 03:21 AM
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Side Note Re:UHC
As far as I know UHC still does not cover lumbar ADR.
However, I highly encourage all UHC policy holders to check their coverage for a supplemental plan called CarePlus. They DO cover ADR. It's a bit tricky to find & figure out but well worth the effort. My husband and I have CarePlus and they have sent my approval letter covering my 2 level lumbar ADR scheduled for Aug 23, 2013. I can't vouch for what will happen once the claims start rolling in but for now they say they'll cover it at 100%. Something worth checking into.  Jen
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"In this world, Elwood, you must be oh so smart or oh so pleasant." Well, for years I was smart. I recommend pleasant. You may quote me." ~Elwood P. Dowd April 1995: L4/L5 & L5/S1 rupture (no injury & still no known cause. I was 22yo)  1995-2013 A long, insane dance with a healthcare saga including doctors from hell & heaven with never ending pain.  July 2013: Insurance approval for a 2 level ADR! Surgery Scheduled: August 23, 2013 
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#5
12-18-2013, 05:47 PM
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Jen,
Did you get your 2 disks and did UHC pay for them??? I'm picking new insurance plans for my company and am wondering if I switch to UHC Select Plus Platinum plan... Was the CarePlus a plan or is it a supplement? THanks, chris
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Chris Back and Neck Pain 30+ years, Chiropractic care Several Epidurals and Blocks over past 5 years Awaiting Insurance for 2 ADR Lumbar L5-S1 L4-L5 Discogram showed Shredded L5-S1 5 YO MRI of neck shows straightening of cervical spine, issues at C4-5 & C5-6 and C6-7 (central disk protrusions, bilateral uncovertebral joint arthropathy, moderate neural forminal stenosis, severe central stenosis with cord compression) Aetna approved C6-7 replacement, scheduled for 11/17 
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