I have CIGNA HMO in Colorado. Denied. I went through all 3 levels of the appeal process. I am very seriously investigating lititgation. Will know where that stands this week.

Brady

FYI: My friend who needs a 2 level low back adr saw Delamarter today. Delamarter told him to wait until September or October of this year to get the 2 level, that is when he expects the prodisc to be approved. Even though he needs a 2 level Dr. D didn't think it would be a problem once FDA approves the disk. For those of you whose insurance is not covering because the prodisc is experimental, this is good news. Hopefully it will be approved in the next 3 or 4 months.

I have Blue Shield of CA and they pre approved my 2 level Prodisc and paid for everything. However, by the time they made all their contractual adjustments they shaved almost $63K off the bill from the Hospital and Surgeon.

Greetings!
I am a 35 WF who battled the state of California to have workers' compensation pay for my recommended ADR. I was injured on 9-24-04 during a physical assualt crisis intervention training demonstration. The demonstrator used me as the "student" and shatered my L5/SI disc in the process. Having a professional nurse casemanager helped tremendously. Also, my orthopedic surgeon provided a handbook entitled "A Patient Guide to the Appeals Process". This step by step guidebook outlines the appeal process and provides content for letters. It is distributed by DePuy Spine a Johnson & Johnson company and may be available by calling 1-800-227-6633. My surgery is scheduled for 7-20-05.
Best wishes,
Crystal

Hi Crystal, That is a terrible story I know only too well. I also was injured by the negligence of a co-worker. Did you have a formal WC hearing or were you denied at an informal level. Can you tell us what turned the events in your favor? Thanks for the appeal lead. Bill