insurance and cervical ADR

[sahuaro]

I am gearing up for an anticipated need to file appeals with my insurance for cervical ADR and need some help gathering information.
(1) Has anyone had insurance, whether workers' comp or health insurance, cover cervical ADR?
(2) If you have been denied cervical ADR, what was the reason for denial? Did you appeal and how far into the appeal process did you get?
(3) Does anyone have or know of insurance which covers cervical ADR? I am aware that, for example, Aetna is covering lumbar ADR but is it also covering cervical?

Thank you for your help!

[Terry]

Sahuaro:

My lumbar and cervical ADR surgery was covered by BC/BS Michigan. They denied twice and ultimately paid. Very nice of them though I maintain my repairs would have cost double in the US and would have required a fusion at several levels. I think they realized the money savings made it worthwhile and paid it.

I have been very happy with my carrier and, as the Executive Director of our company, believe I insure my employees with the best insurance out there. I insure about 23 employees and their families.

I sent you a private response awhile back about the Prestige disc. Did you get it?

Good luck to you.

Terry Newton

[sahuaro]

Thanks, Terry, your info is really helpful. The choice for me is 1 level ADR or 2 level fusion and it sounds like I should stress the financial implications of the choice.
Insurance coverage is important not only for the surgery but also for coverage of aftercare and any complications that might arise.
And every precedent of coverage of ADR is important, so I intend to pursue whatever appeals are necessary.

[Joanne]

I am new to this site and would like to have help with information on filing a claim to BC/BS for cervical ADR. We are anticipating FDA approval of the Pro-Disc C soon and would like to begin the insurance process.

Thanks in advance for any information, denial, approvals, CPT codes, ICD-9 codes.

Joanne

[sahuaro]

Joanne:
There are CPT codes for cervical ADR but they are in the Temporary category. I am hoping that the CPT board and AMA will switch the codes to permanent, especially now that the Prestige has FDA approval. The permanent codes indicate that the procedure is accepted by the medical community. The 2008 CPT book is out but the codes are still Temporary. However, there can be revisions to the codes made between publication of the books.
Apparently, the codes for lumbar ADR were switched from temporary to permanent in January, 2007 and hopefully this has made a difference in dealing with insurance companies--but it would be helpful to get some info from the community about this.