In person appeal granted

[Nichole]

I just received the letter stating that my "in person" appeal has been granted (like they can deny me anyway) and it is scheduled for March 28, 2005 @ 2pm. I get a whole 15 minutes to "provide additional informationtion that may be helpful to the Panel in considering my request". 15 minutes.....please.....do they think I am an auctioneer or what?????? This whole thing just gets more frusterating as time passes. DuPuy has planned to send out a representative to attend the appeal with me but why? for 15 minutes? They also want new information. When I spoke on the phone with the appeal coordinator she basically told me that I can go ahead an appeal to the highest level but they will still deny based on investiogational. She said "the FDA even said themselves that they do not know the longterm outcome and efficacy (spelling???) of the Charite. Until that information is provided Regence will continue to deny all pre-auths and claims for this surgery". Ok, so after that comment and just finding out that I have 15 minutes to appeal why I need the surgery......my hope has just gone out the window.

I do not have the finances to have this surgery here or out of the country. I had hope that my insurance company would come thru eventually. but it sounds as if that may just not be the case.

The last piece is I need "new" information for this appeal. "New" meaning something that I have not already sent in my last 2 appeals. I dont have any more information. I have sent them ever piece of information that I could get my hands on. 180 pages of information.

Anyway, I hope and pray that the rest of you dont have to go through this hell with the insurance companies. I know that at some point they will be forced to approve but I can not wait that long.

Sincerely,
http://adrsupport.org/groupee_common/emoticons/icon_frown.gif

[Harrison]

Nichole, did you see the this latest study? (http://adrsupport.org/private-cgi-bin/ultimatebb.cgi?ubb=get_topic;f=1;t=000223) I was surprised that more people did not comment on the significance of these findings -- this is a huge deparature from the status quo!

The real question for your stupid insurance company is why they want to deny you a "better" medical solution...

http://adrsupport.org/groupee_common/emoticons/icon_mad.gif

[bmills]

Nicole, the A-MAV and Charite study is supposed to be coming up by early April. Have you been able to find any more on that option? The A-MAV is the modified Maverick with the shorter keel.

I'm still considering it if my insurance does not approve the Charite request.

Brady

[cervie queen]

nicholle: You are such a trooper to hang in there. The insurance companies depend on intimidation and you have proved that you can't be intimidated. Thank you from all of us for hanging in there so long. Eventually I feel that insurance companies including Medicare will fall in line and routinely approve ADR. I wonder if the insurance companies can be intimidated right back by all the possible suits that will follow because of their denials. Our alternatives are (fusion or do nothing) neither of which are desireable. I certainly hope that they have taken the time to read your 180 pages of evidence and testemonials. Good luck.

[biffnoble]

You're ALL amazing! http://adrsupport.org/groupee_common/emoticons/icon_biggrin.gif

[BlueLudeDude]

Does anyone know if ADR treatments are being done in India? You mentioned that finances are the major stumbling block for you, and I found an article about a guy who had a hip replacement done at a clinic over in India and payed only 25% of what he would have paid for the same surgery here. Here's the link: http://www.newkerala.com/news-daily/news/features.php?action=fullnews&id=72682 . If this article is legitimate (let's hope so), who knows, maybe we'll all be having ADR's in India by the end of the year. http://adrsupport.org/groupee_common/emoticons/icon_biggrin.gif

[Alastair]

ADR is being done in China, however the person who went to see this did NOT have the proceedure done there.Cost in China �3,000

India is a good health system and cheap E mail a hospital for details

[Linda]

Nichole,
We like you did not have the money to go overseas which was the only option for me, because FDA would not allow a 2 level cervical here. I had already had 2 lumbar levels done in the FDA study back in 2002 and knew that the ProDisc worked for me, so I was freaking out at the thought of a fusion. With a lot of checking things out we found out that we could borrow the entire amount to go to Europe from our 401K plan and cut our contributions to it to be able to begin paying it back with no out of pocket a month costs. We prayed a lot and after 3 months it all came together. We made the trip to Bogen, Germany in January and I had the surgery. God even saw fit to have someone give up three seats in Business class and take my seat on the plane in economy so that I could lie down on the trip back to the States. It was incredible how it all came together!
Best Wishes,
Linda

[cavalier]

Good luck Nicole - I have my 3rd appeal also in person this coming Thurs. - same amt. time alloted. Of course it is a 6 1/2 hr drive each way for me & I still have a ahrd time sitting esepcially that long so it will be interesting - will cost us a hotel stay too the nite b/4 , but I am gambling that we will fight to still get some of the well spent 21,5 K we paid plus plane plus hotels that we wont get back
It is BCBS PPO we have & I had Pro disc done my arguement is the procedure to prep for this disc is the same as a fusion is or for the Now approved Charite that BCBS is paying for - just dont pay for the disc only 3k of that expense for overseas at the time - they will be paying only for international rates also discounted

I am saying pay us something or I will have to go to atty - & they can pay if we win & I will want a jury trial.

Anyone with BCBS info is appreciated - PM me - thanks - & good luck - Jill

[DWebster]

Nichole and everyone else, please check you the thread I started "community appeal Letter" we should try to get this togeather in time for Nichole's appeal. Please this is very improtant to her and for everyone else that is going thru this. We can help and should help, it is are job as caring people to do this. I wish we had more time but she does not have it!!

Dave

[Nichole]

Everyone, Thank you so much for the support. I dont think I would make it through all of this without each and everyone of you. DWebster, thank you for initiating the appeal letter. I think that is a great idea. We can all work together to beat the insurance companies. I will do my part to make suggestions as well. I am going to email you the appeal letter that I have already sent. Thanks to Leanne for emailing me a copy of her appeal letter for me to use, was very helpful. In the appeal letter however I did not point out the difference between the fusion and the ADR. I focused on what I have gone thru up to this point and the wording of my policy. Obviously that didnt work. Their ONLY reason for denial is NO LONG TERM RESULTS AND EFFICACY (spelling??).

Anyway, thank you for the help. This truly is a miracle to have found this website.

[DWebster]

You are welcome Nichole,

I am not out of the woods yet my self, who know I may need this document before things are done.

[Patrick]

Originally posted by Nichole:
Everyone, Thank you so much for the support. I dont think I would make it through all of this without each and everyone of you. DWebster, thank you for initiating the appeal letter. I think that is a great idea. We can all work together to beat the insurance companies. I will do my part to make suggestions as well. I am going to email you the appeal letter that I have already sent. Thanks to Leanne for emailing me a copy of her appeal letter for me to use, was very helpful. In the appeal letter however I did not point out the difference between the fusion and the ADR. I focused on what I have gone thru up to this point and the wording of my policy. Obviously that didnt work. Their ONLY reason for denial is NO LONG TERM RESULTS AND EFFICACY (spelling??).

Anyway, thank you for the help. This truly is a miracle to have found this website. Nichole,

I have found some long term results of the Charite Disk replacement. Go to the ADR Support homepage. Click on Information Resources. Click on Professional Articles. Scroll down to the last article on Artificial Disk Study and open that up. The last paragraph on page 4 and first paragraph on page 5 goes into 5 and 10 year success rates of the Charite implant from other countries. This report also shows alot of comparisons between fusion and ADR and how ADR is as good or better than fusion in many aspects.

My apoligies if you already have this info.

[Nichole]

Patrick,

Thank you for the suggestion but unfortunately I already have that. I also sent it to my insurance with that particular information highlighted with my last appeal. Unfortunately they want US information.

[Patrick]

Originally posted by Nichole:
Patrick,

Thank you for the suggestion but unfortunately I already have that. I also sent it to my insurance with that particular information highlighted with my last appeal. Unfortunately they want US information. Well, if they want long term US studies to approve the procedure, I don't know what hope any of us have right now. How depressing.....