BC APPROVED!!!!!!!!!!!!!!!

[Laura C]

Well, it has been a struggle but I won my appeal. Insurance company is BC of CA thru the Directors Guild of America. I was denied twice. I appealed to the Board of Trustees of the Directors Guild. The first step was that they sent it out to an independent review and they denied it. The Trustees decided to overturn it because of the complexity and unusual circumstances of my case.

I will be HAPPY to send any info, including my letter to anyone that needs it. I also received a very large packet from Charite/DePuy that had a large amount of info and guidelines for appealing. You can call them and have it sent to you - very easy!

However, I will not rest until the surgery is over as we all know how the insurance companies can turn our lives upside down.

Thank you, all of you for your support and help and will keep all posted.

Happy Holidays!!!!

[Harrison]

Way to go, Laura! Congrats on your milestone!

PS: Your future surgery sounds tricky...what will they do to your lumbar spine?

[Laura C]

Thank you, Harrison!

Dr. Regan is going to fuse L5-S1 because of the broken (or missing) facet joint and ADR on L3-5, L4-5. I am nervous as I know that I will be in alot of pain after the surgery, but what I am going thru now might be worse.

You mentioned the word "tricky" - your thoughts?

[JeffreyD]

Laura,
That's great news. I think 2006 is going to be a wonderful year for you!
God bless,
Jeff

[luvmysibe]

Congratulations on your approval! Now you can look forward to recovery and healing! Take care!

Laura,
Congratulatins on winning your approval! Persistence pays off!

Will your surgery be at Cedars?

How long will you be in the hospital? Do you go in the morning of? I'm interested in hearing any of the details.

You'll have a fusion and two ADR's? I hope they keep you as long as possible in the hospital!What is their plan for you?

Dr. Regan is also my doctor and I am waiting for Medicare to start paying for this surgery. Would you send me the info that you mentioned? I am going to write a letter to a person at Medicare and I need all of the supporting info I can get.

Best wishes and Happy Holdiays!

[Mariaa]

Laura,
Congrats.. it's wonderful to hear your persistance paid off! While my battle is with WC, quite possibly a similar arguement would be helpful to me. I have definately 2 and possibly 3 levels to be replaced. Will pm you~
Way to go~ Maria

[Laura C]

Hi Everyone,

I am going to get the rest of my appeal into the computer so that I can email the files to anyone who wants it. It was 85 pages long so give me a few days.

Also, I STRONGLY recommend sending for the appeal packet from DePuy (Charite ONLY) as I took lots of info from that. It really is an amazing tool for appeal.

The only thing that I cannot release are EOBs or letters of approval that I have received from some of the kind members of this board. You will have to ask for them - perhaps start another topic so that people can email or fax their info.

Will keep you posted.

DO NOT GIVE UP!!!!

Laura, I'm so happy your surgery was finally approved. I wish you all the best for your surgery and look forward to reading about your post-op recovery. My surgery is Nov. 30th, but is only one level ADR at L5/S1. I received a letter from my insurance company stating that mine is medically necessary, but have no details as to what is 'approved'. I'm hoping to find out more tomorrow; shouldn't I receive a more detailed notification of what expenses the insurance company will pay for? I'm assuming they pay for everything. If so and if I get it I will post it on the forum, or should I just email it to you? Take Care, Kim

[Juli]

Hello Laura,

I had the same surgery done and am 10 weeks post op. I go back to work in 2 weeks. Let me know if you have any questions. I posted a bit on the surgical outcomes bucket.

Good luck!

[Judy]

Hi Laura, I would greatly appreciate asnything you can send me on your appeal process. I am currently in the process of appealing Cigna Healthcare for my surgery.

Thank you in advance for your help.

Judy

[ans]

Laura: You kicked butt in your perserverance. Also, I wish you the best for your surgery. Finally, thank you for helping others obtain approvals as a result of your v. hard work. - Allan

[dan]

Hi. I just receivd a letter of non-certification from my insurance company, Blue Cross. I need a disc replacement at L5. Rick Delamater is slated to perform the surgery (using a ProDisc) on October 5. I would be greatly appreciative if anybody has any thoughts or suggestions as to to the viability of appealing the BC denial.

Alternatively, my wife has Great-West availble to her--does anybody know if they cover this surgery?

Lastly, if Great West doesn't, and my BC appeal is not fruitful, I am starting a new job in January and will be able to choose from many insurance companies--which ones cover this procedure?

Thank you in advance.

dan lowenthal
long beach, ca

[David]

Not that this helps, but, to my knowledge, you are the first person to receive a denial for U.S. Prodisc (that I have heard of)

David

[dan]

You mean companies are approving ProDisc right now? If so, which companies? Rather than enter into a protracted battle with Blue Cross, I'd like to just sign-up with a company that will do the right thing.

[David]

What I mean to say is that Prodisc was FDA approved about two weeks ago, I seriously doubt that any insurance company will cover Prodisc surgery for quite awhile.

(ie, you are the first person to post that has asked for Prodisc coverage. I plan on waiting until mid-October to ask for my Prodisc denial)

Charite was FDA approved in 2004, and many insurance companies continue to deny people for that a particular device.

David

[jf110]

Laura,
Congratulations to you on your approval. I went through three appeals back last year when i finally got my approval for ADR surgery at the Texas Back Institute. My insurance was BCBS also. I am glad you stuck with and won. Mark

[Mariaa]

Laura,
Have you had surgery yet? If so, how are you doing?

[Mariaa]

Dan ~ are you in Long Beach? So am I..

[dan]

Yes, I am in Long Beach--my family lives in the Rose Park area. My local physician in Eric Feldman--he referred me to Delamarter.

[Eddie_G]

Well I'm about to open up a can of whoop-arse on Liberty Mutual. I hope to do it without a lawyer. I'll keep you posted.

[Abbe]

Hi Laura,
I just got 2nd denial from Motion Picture Blue Cross. I would love to know how you got approved. I am looking at L3 L4 Prodisc replacement. Any help would be great!
Thanks,
Abbe

[motorman_darian]

Hi, I'd love to see the letter granting your successful appeal. I'm in the process of trying to get Aetna to approve a 2 level ADR at L4-L5 and L5-S1. I've been somewhat successful, I did receive approval for a 1-level ADR and the other for fusion, but from what I've read I think I'd be better off with 2 ADRs. Please email me at dgasgari@gci.net any information you think would be useful for my appeal. Thank you so very much!

[gosolar]

I am putting together a packet and will be very happy to share with any interested. I am working to get a second Prodisc from Blue XS. I will keep you posted.

Harrison, I am SORRY iwas an idiot and idn't see the links before. Please accept my apology.

Meg

[Harrison]

Meg, no problem. There's too much information here for anyone; it is a challenge to organize. Good luck with all, and pls keep us apprised...

[LBP]

motorman,

I am concerned that you are having problems getting 2 levels of ADR approved???? Everyone on here before seemed to have no trouble with multi levels with ADR. Why would Aenta approve 2 level Charite eaiser than 2 level ProDisc? Or are they tighening up on their approvals????

Anyone know more?

[Laura C]

I am sorry that I a have been away for so long. I will find the papers that will be important for an appeal and any info showing that the insurance covered it should help too. Anyone still wanting this info, could you please email me? Thanks!!!!

[eileen gallagher]

Laura,
I am gathering info for my 33 year old son, who has Empire BC/BS thru IATSE (International Actors Theatrical Stage Employees). since this union is in CA, I am hoping to have some sucess (my son lives in NY). My son needs a two level L4-L5 and L5-S1 (probably ProDisc). At this point the plan is to go to Germany but that might change if we could get paid in the US. Any info you can provide would be helpful (your approach and timing).

[phylly]

Hello Laura,
congratulations on your approval. I would also like the information on your appeal. I also have BC and was denied. I have BS as my primary and they denied me first the BC. I appealed to the IMR. I was denied again. I will still appeal although I already had the surgery by Dr. Delamarter and was a cash pay. I am so happy for you. I hope you do really well with your surgery. Keep us posted. this gives me some hope. Thanks for the info.
Phylly

[phylly]

Laura,
Please swend you email again I could not pull up you URL. I would love the info on your approval I am still woking on getting it retro approved and any thing you did would be very helpful.
Thanks so much,
Phylly

[phylly]

sorry about the spellings, I did not check them.
Phylly

[ctesch]

Laura,
Could you send me a copy of the appeal letter you used for BC?
I have 3 levels in the Lumbar region that need replacing.
cathytesch@wildblue.net

[SandyB]

Hi Laura,
I would love a copy of any info you can forward to me. BC just denied me yesterday.
You can pm me for my info.
Thanks!
Sandy

[kimmers]

Laura,
I too wouldn't mind a copy of the appeal letter you used for BC because I was denied last week and we are appealing; I need L4/L5 replaced with Prodisc. I would appreciate it.
You can PM me and I'll give you my e-mail address.
Thank you,
Kim

[steve]

Originally posted by Laura C:
I am sorry that I a have been away for so long. I will find the papers that will be important for an appeal and any info showing that the insurance covered it should help too. Anyone still wanting this info, could you please email me? Thanks!!!!

[steve]

Laura C
My name is Ken Vance.I received 3)Pro-disc &
fusion a year ago via Dr. Bertagnoli,and am in the process of forwarding a claim to BCBS for reimbursement. Would it be possible to receive from you any documents that may be of help?Please e-mail me if you have any questions. I
hope your procedure is a success...sorry to be brief...I still have problems with extended sitting and I have been searching for information for too long for the last few days.
Thank you again for any help you can forward.My
email is kavance125@aol.com

[kimmers]

Laura,

If you have the appeal letter, I would appreciate a copy. I am fighting Blue Cross for ADR at L4/5. Pls e-mail me at trackgirlnut@yahoo.com. I would appreciate it. I need all the help i can get.

[Amber]

Hi Laura,

We would love a copy of your appeal letter. We are in the process of putting ours together now. We are battling with BCBS of CA, so any info is greatly appreciated. Please email me at mysnappypants@yahoo.com

Mark (and Amber)
Age 40 Injured in 30' fall in 1986
L4-S1 Pro-Disc (in Germany) 4/9/2008
Recovering well, but battling BCBS of CA

[Diane]

Amber--

As of 6-15-08, BCBS of Illinois will now cover single level cervical ADR. You may be able to use the "affiliated company" peer pressure to get yours to do it. If I understand correctly, Oklahoma and 2 others will cover it as well--I have this document in writing.

If you need a copy--email me at djerdee@merr.com.

[geopoman]

Diane,

I would like to ask for a copy of the 6-15-08 policy of BCBS. I am in Oklahoma and need a single level ADR at c6/7.

Thanks,

Greg
greg_leaver@yahoo.com

[ans]

I would greatly appreciate a copy of the copy of the BCBS policy. Also, please, a copy of the appeal letter BC of CA.

Thanks in advance. - Allan

bicycletes@yahoo.com