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View Full Version : anyone get blueX to cover prodisc


Julaine
05-22-2007, 09:42 AM
I see DR. Kropf at the spine institute and they are wantng to do a ADR and then remove hardware from a fusion. Blue cross says they will pay for the surgery butnot the disc or the vascular surgeon. Anyone else have this problem?
thanks
Julaine

CHILLEE
05-22-2007, 11:38 AM
Harrison just put up a great thread from an awesome lady on how to fight your ins. co. and appeal the big "NO". I would start with obtaining a copy of that book, it seems to fit alot of our situations on this board. Cheers!

ZorroSF
05-22-2007, 05:58 PM
I know blue cross is covering ADR in San Francisco at St Mary's, but it could be another story in another state. A revision surgery also adds another twist to coverage. I'm not so sure revision surgery is as common as a first-time ADR surgery.

Even St Marys had a heck of a time trying to get blue cross onboard, but they were covering it by end of last year. At the same time St Mary's is also one of the original trial centers for ProDisc, so I'm sure that was also a factor.

BTW I couldn't imagine being 32 days in the hospital. I was going nuts after 6.

ZorroSF
05-26-2007, 11:23 PM
well I am mistaken. I just received the bill from St Mary's stating that Blue Shield will not cover the disc or the surgeon's bill, but they paid most of the hospital bill.

This is whacked. I was told by my hospital that blue shied of California approved the procedure.