Blue Cross Blue Shield {aka Blue Crap}

[chasswen]

does anyone know how many people are needed for a class action law suit?
and secondly how many people here want to sue Blue Crap?
i am in the process of submitting bills from Adr in Germany. sending the bills to IBX indepenant blue cross and another copy to Blue shield worldwide.
the law suit would be about there double standard between fed employees and privitey insured.
chuck
p/s i xpect IBX to turn down request for payment i surely hope i am wrong that would reflex there true colors.

[Nairek]

Hi Chasswen,

I’m not sure how many people are needed to file a class action lawsuit. It may vary on a state by state basis. I’ll try to find out the answer for you though.

I received notification from Empire BC/BS the other day that they have denied my 1st level appeal to have the Charite ADR surgery. I am gearing up to fight them with my 2nd level appeal as I only have 45 days to get that in. Happy Holidays huh? http://adrsupport.org/groupee_common/emoticons/icon_rolleyes.gif

My OS wishes that an attorney would come forward & file a class action lawsuit on the behalf of those denied by their insurance companies. The problem, there really isn’t any money to be made by the attorney if all they are fighting for is to allow people to have the ADR surgery & have their insurance pay for it. Also, who pays the attorney’s fees? It would be great if DePuy Spine & the other manufacturers of artificial discs would assist us in fighting the insurance companies and have them foot the attorney's bill.

I hope that everything works out for you & that you receive reimbursement for your surgery. Please keep us posted on this as well as your recovery!

[chasswen]

well it seems that if you work for the gov. and insured by the feds they must pay for any thing fda approved. but once you be come privately insured that changes its not right.
karin i think they would approve the prodisc before they would approve the charite. they hate the idea the center can come out if not installed correctly and the study compareion with prodisc is more apples to apples.
chuck
ps you may want to try for approval using prodisc

[davidj8121]

Chuck,

I think this is an older post but the Class Action Lawwsuit against BCBS I would think could be feasible. Is there any level of interest from others? Even if we all got half the money back and gave half to the attorney it would be better than zero. There has got to be hundreds, if not 1,000's of BCBS people that could be interested. At $20,000 per for an attorney it could be very interesting for someone I would think.

Unfortunately this may be what it takes to wake them up to the fact that ADR is not going away.

(Clarification: if we could all get reimbursed in full from BCBS as a result of the lawsuit we would then in turn give some percentage to the attorney.)

Dave

[chasswen]

hello David
congrats on your up coming surgery i will be sending you positive thoughts.
yes there are some others interested. i am in process of waiting on bluecard worldwide reply for request of payment for my surgery they have asked for a itemized list of cost from my surgery with dr. bertagnoli. so if i am denied i will be tracking down a lawyer to sue those pricks and will be looking into a class action suit. i will keep all posted on the out come.
again best wishes for your up coming surgery.
May The Force Be With You!!
chuck

[Abbe]

Yikes! I guess I could be in for a battle! I only have 16 months left on Cobra with Blue Cross Blue Shield. I was hoping for a fairly quick resolution. I am waiting for Dr. Lytton Williams's letter and I have a packet I have been putting together with research to send to Blue Cross Blue Shield. Has anyone been approved by them for Disc Replacement? I am in California. Any suggetions? I am open....

Thanks,
Abbe

[LBP]

abbe,

I would seriously consider looking into whether you can get Aetna. I cant take out an invidual policy for Aetna in my state but they do offer that option in some states. Might be worth investigating. I haven't heard of anyone yet declined by Aetna. Officially their policy says they only cover 1 level but they have covered 2 levels. not sure about 3 but they are your best choice. I thought Kaiser was also covering ADR. The downfall with Kaiser is that you are limited to their drs and I'm not sure any of them have that much experience since I've never heard of a Kasier dr involved in any of the trials.


Otherwise...you really should consider Germany being a 3 level

I am very very curious how you got started with Dr. Delamarater's office to try and get FDA approval for an exception to the ProDisc 2 level trials...even if you didn't get any follow through...how did it get started? I'd like to see if there is a way to get a 2 level exception to the new ActivL single level trials.

[katiejane]

p

Chasswen,
I have BCBS Federal Employees insurance. Are you telling me that if a device, the Prestige artificial disc, is FDA approved, however, still considered investigatioal, they cannot deny me the surgery? I heard there was such a federal mandate and passed it along to my doctor to help fight BCBS. I need two disc replaced in my neck, so we asked for a fusion and a Prestige and were told no, only fusion. I have been excepted into the Wallis Clinical Trial Study for a disc needing replacement in my lower back, so at least no insurance hassles there.
---KatieJane---

[Diane]

Katie--

Google "FEHB FDA"--you are looking fro a pdf that indicates that all providers of federal employee health benefit plans need to adhere to the FDA approvals and cover the procedures. Now, the only approved use is single level, not sure about adjoining fusions or not, but that's how I would fight. if you cannot find the letter, email me at djerdee@merr.com and I will get you a copy.

[Berylcooks]

we are suing Blue Cross. Just saw your message. Let us know if you want to join is.
Berylcooks@aol.com

[chrislaxtell]

i am new to this but am very interested in lawsuite against bc. i have bcbs of north dakota through my employer and they are saying pro-disc adr is investigational. i am in the process of sending 2nd appeal.

[Jstuckey]

Best wishes. I appealed my insurance (not BCBS) 4 times and was still denied with the "investigational" claim. In my case, they said (only on the last appeal when actually looking at my entire medical record) that it was the multiple level deterioration that had not been studied, therefore making it investigational for that use. (I would have had a fusion below and 1 ADR). So they would have paid if it was a single level? I highly doubt it....
Borrowing a ****load of money from my parents instead....

[semathes]

I would like to join forces with anyone who has experience with Anthem BCBS or any other BCBS for that matter.

I'm in need of any successful coverages, appeals, court cases, etc. for lumbar ADR.

[christinlal]

We sent a summarization of my nightmare to a health care attorney.

[andrea32225]

I'm in the midst of a battle with Anthem myself. Just got my first denial back today. Am waiting to see if they will approve a repeat discectomy (which will leave so little disc they will have no choice but to do a fusion or ADR), before I decide about the 2nd appeal. Will hopefully know something Wednesday. Evidently our Anthem policy is the only type that does not require pre-cert for lumbar fusions!

Thought this was on my signature already - 2x epidural spinal injections, 3 mos physical therapy, herniation at L5-S1 w/microdiscectomy on 7/5, re-herniation shortly thereafter

Doctor who performed appeal made numerous factual errors based on info submitted by doctor to go with appeal. Does that matter in anything?

[Jmbeam]

Has anyone been successful in Suing BCBS?

[ally]

I am very intereted in BCBS as I hav it in Alabama and was told that disc replaement would not be covered. I am also planning on getting a lawyer when the decision is made on what Dr. I go to and what disc is decided that would be best for me. Im such a noob here also lol.