FYI - I asked them to exclude my Prodisc device since they are saying it is experimental & they have still denied paying ANYTHING for the surgery wich is the same prep as a fusion except the device is different or paying anything for the doc - even thoguh other insurances have paid this way excepting the Prodisc - & their own BCBS in other states have paid for all or some of it - They are saying I have 90 days to appeal but this now requires an atty to be hired by myself according to their ltr.
This is in Tn.
I had ONLY asked for 60% of the 21,5k minus 3 k fopr the disc cost I ahd surgery voerseas - & Dr. Bertangoli is now a preferred provider by BCBS
IF ANYONE knows of any atty. willing to take cases like this please PM me - seems most atty's dont like to have to go after insurances being told it takes too long - seems to be quite a racket - Jill

I know of one law firm that specializes in insurance cases. I met with them and intend to use them if my first appeal does not work.

I will also PM you.

Brady

I am wondering how the insurance company can require you to have an attorney - are they indicating that the case is going to Court right away?

I dont understand it either.
As to going to court - NO actually they are saying this would be if I try it again a final decision is what THEY are trying to state there will be no further action.
HOWEVER that is ONLY to their advantage as they are NOT wanting this to go to trial - so it is time for me to get an atty - as this is ONLY in foavor fo them in their trying to do this. However in Memphis only one atty out of 38 I have called will even take it - as they all say it is too hard to go up against insurance companies. It's a real racket & I cant say this the insur. company is playing fair at all -
Jill
Jill

If the court system looks iffy, how about trying your case in the media. With all the hype about the success of ADR and the recent FDA approval, the public sentiment should be very pro-ADR. If a major newpaper wrote up your story painting the insurance company out as some dishonent, greedy organization denying a valiant, hardworking women the money she was rightly owed, that might give you some leverage. On the other hand, they might not even care. Have you contacted the insurance commissioner or relevant government body in your area?

Hi Anna - thanks for the info. I WANT it to go before a jury it is the Insur. that does NOT !

They are wanting it closed saying this decison will be the final decision - Of course it is totally lopsided as they think they are driving this bus. SO it is TIME to get a atty to fight as this is NOT going to be the last decision & I will take it as HIGH as I have too.

I can take it to the press - as this state is the only BCBS state that I know of that is still dragging it's feet in paying for ADR - all of the other states are paying or starting to pay - how progressive is that ?
Will see if they have any interest -
Thanks - I have to still contact the commissioner although I have been told they are in the hands for the insurance not the insured -
I am going to check with an atty on that 1st & see if they have any thoughts or contacts 1st- Jill

I can't remember if your trying to get reimbursement under PPO coverage or HMO coverage. Have you tried to appeal to any agency outside of the insurance company? I know in Calif. appeals can be made the Department of Managed Care which oversees the HMO's. I've used this avenue quite a few times and have been quite successful. I haven't tried for major surgery though yet. If it's for PPO Coverage then I'm not sure what agency you could appeal to except the Insurance Commissioner in your State like you mentioned.

Spotty Hi - it is a PPO

Jill

They are insane. My Empire BC/BS of NY offered to pay for a two-level disc replacment (Empire Health Choice of NY).

And I'm with a Group PPO.

Sorry for this re-posting.

Dont be sorry Ans http://adrsupport.org/groupee_common...icon_smile.gif I appreciate the info & YES it IS nuts !
They know that other BCBS states are paying they are acting like their own entitity unto themselves.

Jill