United Healthcare Appeal

[bgeary]

Hello,

I'm scheduling a C6/C7 Pro-Disc replacement with Dr Zigler at Texas Back Institute in September. I know United Healthcare will deny the request. My question is, has anyone succefully apprealed and recieved any judgement / payment from them after the fact?

Thanks

[Harrison]

B,

Yes, but success after the fact is rare. Hire an attorney.

[jss]

bgeary,

My experience in appealing to BCBS-TX after the surgery was a glorious failure. Using mountains of peer reviewed journal publications and clinical data, I thoroughly refuted every objection that they presented. At the end of the day they simply had no incentive to reimburse me. Because I was developing myelomalcia, which is often fatal if spinal decompression is not performed immediately, I did not have time to fight the approval battle before surgery.

If you have the option of postponing surgery for several months (I didn't), I would encourage you engage in the ADR approval battle before surgery.

Either way, at the hands of Dr Zigler, you will have the absolutely best possible outcome with a ProDisc that can be had.

Please keep us posted, and good luck!

Jeff

[gymnast1981]

Im currently fighting with UHC to overturn their 1st denial of ADR. I just had the conference call between 3 panel members at UHC, myself, my husband and an company that is advocating on my behalf. I hope to hear the decision with in the next week!!! the horrid week wait! I can't stand waiting and not knowing whats going on.

Has anyone gone through an appeal that went to a conference call? and if so how did it turn out?

[jss]

Becky,

There are members on this board that have posted about conference calls with their carrier, from their doctor's office; but only two or three. I don't recall their online ID's.

I am curious... Were you able to obtain the backgrounds of the three member panel? Did any of them have backgrounds in spine pathology? Or did you get some assortment of a podiatrist, gynecologist and a proctologist?

We'll be on pins and needles waiting on their decision with you. Please keep us posted.

Good luck, Jeff

[gymnast1981]

Jeff,
Actually I did not think of it at the time to ask about their backgrounds. I was so anxious and stressed out that it totally slipped my mind. I wasnt exactly expecting this appeal call so quickly. I thought it would take longer to get to that stage but I guess they are trying to "get rid of me" which is fine... accept it and I'll stop hounding you :)

The advocy that is representing me is more concerned with the next appeal (if it comes to that) which will be a specialist from my state (Wisconsin) and someone that is a neuro surgeon that has experience in ADR and fusion. I guess at least we still have that to fall back on.

It means a lot to me that others are intrested in my case, I know I am very intrested in everyone elses and I hope that if I do get overturned I can use my experience to help others!

Thanks and I will for sure re post when I hear news (fingers crossed it is YES)

Has anyone else used an advocacy? My doctor set me up with them. And so far I have been very pleased by the way they are handling my appeal!

[gymnast1981]

UHC has denied my claim for the 2nd time... Now time to have the independent review organization review it and make the final decision! lets hope that now a neurosurgeon that specializes in ADR and fusion will make the right call.

i just got the denial letter in the mail and apparently they had a doctor that graduated Med School in 1965 make the decision... UM REALLY??? 1965? the guy has to be like 80 years old. yea NOT COOL

fingers crossed for round number 2 for approval

[jss]

Becky,

If your insurance company is anything like mine, they are concerned with three things (in this order); 1)getting away with not covering a procedure, 2)following their processes and procedures, and 3)your well being.

If you can show them in some way that ADR will cost them less than other treatments, that will probably be your best chance for success.

Wishing you the very best of luck!

Jeff