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-   -   Adr covered by bcbs (https://www.adrsupport.org/forums/showthread.php?t=12537)

jasonhhh 12-23-2013 07:22 PM

Adr covered by bcbs
 
Well I just got my check in the mail from bcbs ny I had a 2 level lumbar disc replacement with the l-m6 done by doctor clavel just went had the surgery done and came home and submitted claim no problems. I think the trick is not getting preauthorization before surgery.im so happy worked too hard not to get the money back

Harrison 12-23-2013 08:45 PM

Jason, do you have the Global Blue flavor of BCBS?

jasonhhh 12-23-2013 09:05 PM

Quote:

Originally Posted by Harrison (Post 103500)
Jason, do you have the Global Blue flavor of BCBS?

im not sure but I know when I went to file the claim they sent me over seas forums not the regular ones which were sent to a different dept to be broken down before being sent to the regular dept is what I was told by the lady I spoke with over the phone

jasonhhh 12-23-2013 09:10 PM

I know dr clavel and quiron hospital except bcbc 100 percent and after I had surgery Yolanda said it will take a few months but most patients are getting reimbursed and this procedure is the norm there so no American experimental crap

bwink23 12-25-2013 02:41 PM

Jason....You are truly a rarity, most people are not getting covered for this. If fact, about 99% of people who i've read that went overseas for surgery are not.

If you would, could you verify for the forum if you have international coverage for BCBS or not, that makes all the difference in the world....Some have full coverage for overseas work performed, some just have emergency coverage.

Did you get the forms from Dr. Clavel, did he submit the initial hospital codes for you or did you have to get that information and do it all on your own?

Jerry5 12-25-2013 06:44 PM

Bcbs
 
jason,
like the others here, can you give some details.

First do you have the international waiver?

You paid all of this upfront?

Did you submit the forms?

What percentage did BCBS cover?

I have BCBS, and should have switched to Aetna, after reading all the fine print, they consider ADR 'investigational'.

This is of course BS.

Everyone should write their Congressman, and ask why the Spinal Kinetics, M6, is not approved for use in the USA, why?

J&J bought DePuy, and it is a cash cow, both the Charite and the ProDisc, are owned by J&J.

Let us know jason, glad to read you have yours.

Jerry

jasonhhh 12-25-2013 08:25 PM

Quote:

Originally Posted by bwink23 (Post 103513)
Jason....You are truly a rarity, most people are not getting covered for this. If fact, about 99% of people who i've read that went overseas for surgery are not.

If you would, could you verify for the forum if you have international coverage for BCBS or not, that makes all the difference in the world....Some have full coverage for overseas work performed, some just have emergency coverage.

Did you get the forms from Dr. Clavel, did he submit the initial hospital codes for you or did you have to get that information and do it all on your own?

dr clavels office gave me the full bill written out with cost,codes I submitted myself to the insurance company with a copy of my wire transfer I had to pay in full before operation, the insurance company gave me a international forum to fill out

jasonhhh 12-25-2013 08:29 PM

Quote:

Originally Posted by Jerry5 (Post 103516)
jason,
like the others here, can you give some details.

First do you have the international waiver?

You paid all of this upfront?

Did you submit the forms?

What percentage did BCBS cover?

I have BCBS, and should have switched to Aetna, after reading all the fine print, they consider ADR 'investigational'.

This is of course BS.

Everyone should write their Congressman, and ask why the Spinal Kinetics, M6, is not approved for use in the USA, why?

J&J bought DePuy, and it is a cash cow, both the Charite and the ProDisc, are owned by J&J.

Let us know jason, glad to read you have yours.

Jerry

believe me I was surprised myself it took me a couple years to save up for this operation I still cant believe I was refunded without a fight
I don't know about my international coverage but ill find out at a later date,
I paid all cost upfront
BCBS covered 100 percent
I submitted forums from dr clavel to BCBS

2Confused 12-29-2013 10:40 AM

Congrats Jason!!

I recovered 60% from BCBS after cervical surgery with Dr. Clavel. Am I reading correctly that you received 100% coverage from BCBS? That is wonderful!:clap:

Quote:

Originally Posted by jasonhhh (Post 103518)
believe me I was surprised myself it took me a couple years to save up for this operation I still cant believe I was refunded without a fight
I don't know about my international coverage but ill find out at a later date,
I paid all cost upfront
BCBS covered 100 percent
I submitted forums from dr clavel to BCBS


Jerry5 12-29-2013 01:25 PM

Reply
 
Thank you for the reply, this is good news.

This Dr Has a lot of experience, so does the team in Germany, ONZ, Bierstadt (SP) so this is a factor in their decision, I emailed the FDA, and they said this M6 is only for Export Sale.

Let us know about the international rider/waiver, I looked at my (BS)BC BS, and it states right there, this is 'investigational' (ADR), what this means, is they don't want to pay.


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