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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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I haven't had the best luck with Blue Shield in the past, but within 5 minutes they authorized my request for a ProDisc replacement at L5/S1.
Anyone else have Blue Shield?
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*********************** 1/2006 DDD L5/S1 Prodisc St. Mary's 12/2006 not diagnosed properly pre-op and now have DDD L4/L5, facet calcification L5-S1/L4-L5, mild scoliosis and left knee pain. DDD: C3 through C6 |
#2
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Great news Zorro! How was your request submitted?
Justin |
#3
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I really don't know. I just spoke with Dr. Zucherman's assistant and she said there is a new code they use for disc replacements (one that covers both discs). She wasn't surprised at all, but I was taken back.
She said that Blue-cross is pickier than blue-shield and even they authorize disc replacements now. Something must have just advanced in the insurance industry cause I've read nothing but agony from people here trying to get their insurance to pay for disc replacements.
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*********************** 1/2006 DDD L5/S1 Prodisc St. Mary's 12/2006 not diagnosed properly pre-op and now have DDD L4/L5, facet calcification L5-S1/L4-L5, mild scoliosis and left knee pain. DDD: C3 through C6 |
#4
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It's a great feeling 'aint it? They are finally coming around. Congratulations!
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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 |
#5
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Well, I am surprised to hear this. But don't forget:
- some requests can be specific to the individual; - each BCBS operated as legally autonomous entity within each state; - this may not mean a policy change, for the above reasons and many others. That said, congrats!
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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 |
#6
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well surgery date is the 27th. I didn't lose the 20lbs I wanted to, but I'm 34 and should fair well.
I'm most worried about the scarring that occurs around week 3. I read Deuce's thread and just about flopped my head on my keyboard a few times aganizing what I got myself into, but I think I'll ride it out first. I had the same problem as him; protrusion that kept rubbing up against the nerve root for 10 years. I have some scarring, but the hospital system hasn't seen any reason to stop yet. I go in for a pre-op this friday. I anyone wants me to keep a log on this forum about my surgery in san francisco let me know. I'll start taking notes soon.
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*********************** 1/2006 DDD L5/S1 Prodisc St. Mary's 12/2006 not diagnosed properly pre-op and now have DDD L4/L5, facet calcification L5-S1/L4-L5, mild scoliosis and left knee pain. DDD: C3 through C6 |
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