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!!!!

Way to go, Laura! Congrats on your milestone!

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

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?

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

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!

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

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

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!