Empire BCBS & Cervical ADR?

[Sammy]

Anyone had any luck/knowledge of Empire BCBS and Cervical ADR?

Any feedback would be greatly appreciated.

Sam

Diagnoised Cervical Spondylotic Myelopathy - Stenosis C5-C6
Past history of Hydrocephalus (Shunted and revised)
One Post-op siezure

[Nairek]

I couldn't get Empire BC/BS to pay for a 1 level disc replacement at L5-S1. I lost all of my appeals with them.

All you can do is try & see if they will pay for it. I hope they will come thru for you.

[Sammy]

Karin - Sorry to hear about your difficulties with Empire BC/BS. Thanks to the folks in my surgeon's office (Annie at Dr. Bitan's in NYC), it looks like they will be covering my Level 1 ADR C5/C6 with Prodisc-C.

Not sure how she did it but we did get a call from a BC/BS case worker stating it would be covered - would like to see it in writing though.

[Nairek]

That's Great! If you don't mind my asking, is the plan thru Horizon BC/BS or a different plan?

I wish my Dr.'s office was a little more proactive when it came to my case. I really felt like I was doing all of the work.

Perhaps your surgeon's office can get that info in writing for you. This is definitely exciting news! Do you have a surgery date set yet? Please keep us updated! http://adrsupport.org/groupee_common/emoticons/icon_smile.gif

[Sammy]

Hey Karin;

The plan is Emprire BC/BS not Horizon. As it is actually a co-insurance it's not a super bargain but still helpful. That may explain some of the willingness to pay a portion.

My surgical date is coming soon, Monday 3/10.

While I did not see the actual documents submitted by Dr. Bitan's office I believe the main focus was that this surgery would prevent future onces down the road from adjacent disc damage.

Sam

Diagnoised Cervical Spondylotic Myelopathy - Stenosis C5-C6
Past history of Hydrocephalus (Shunted and revised)
One Post-op siezure

[Sammy]

Just received hard-copy confirmation of my ADR coverage from Empire BC/BS. If anyone is interested I can provide some details.

Sam

Diagnoised Cervical Spondylotic Myelopathy - Stenosis C5-C6
Past history of Hydrocephalus (Shunted and revised)
One Post-op siezure

[mmarsh]

Sam

Please send anything you have. I'm appealing BS of CA, but any "precedent" is helpful.

Missy
mdm798@aol.com

[locorebob]

Sam, Could you please send me the material also, I am trying to get United Health care AZ to cover 0090T procedure (cervical ADR) and have been denied.
PLease send to locorebob@hotmail.com
Thanks, Bob

[SherryD]

I am in the early stages of trying to get approved for the cervical disk replacement surgery (C6-C7). I have BCBS as an insurance carrier and my doctors office has told me that BCBS has not approved this procedure. If you could please share a copy of your approval, I would greatly appreciate any help you can give me. I can be reached at sherry.dortch@yahoo.com.