I am starting the appeal process. If there are any of you that have had ANY coverage from BC and are willing to share these documents with me, please email me and I will send my fax# Any other info or links for studies would be helpful. I don't know exactly where to find the studies - ANY help at all please! This is what I am doing over the weekend.
Thank you.

Sorry, I must have hit the wrong button

Laura,

Unfortunately, I find myself in the same boat. My first appeal was denied along with BC's suggestion that I utilize the Dept of Managed Health Care independent review. Don't!

I have to assume our denial letters were similar. I found phrases used by BC to be contradictory to their basic statements, on which I based another appeal, along with correcting my medical history. They stated that the Charite disc had equal results to fusion... but stated that fusion is likely to affect adjacent discs. They also stated the obvious that fusion fuses, thereby limiting movement. Thirdly, though not proven in another paragraph, they state that the Charite disc was designed with the purpose of preserving movement.

I pointed these statements out to them along with doctors 'findings' since currently no studies state the Charite's superiority. (I asked Dr. Regan's office for literature but received none) I sent them 2 separate letters, certified, return reciept, but still after one week, they have nothing posted as having been received. Maybe... one could get lost... but 2.

I also stated that it seemed that the costs for the covered procedure, fusion, was similar to the costs for the ADR with the exception of the ADRs themselves and offered to compromise on their costs outside of my policy limits.

Of course, I'm ahead of myself, as they claim red tape in reviewing the letters to which, of course, they haven't replied. I'm also positioning myself for possible litigation/arbitration.

I wish us both, and anyone else in the same battle, good luck.

Dale

Dale,

If you're gettting shined-on, why not visit the office and ask directly? (Or: ask pts. in waiting room for "advice" - just kidding).

Sorry you're going thru this.

Allan

Laura, I just got a 2 level adr approval from BC/BS of wyoming on the first try. If I can help let me know. BrendaWY

Dale,
It sounds like you are not getting what you need from Dr. Regan's office, but his name keeps coming up. I don't plan to go see him, but I would like to talk to someone in his insurance dept since they seem to have gotten quite a few approved. If you have his phone number and maybe the name of someone in his office who is knowledgeable and would like to share, I just want to ask them a few questions. I have UHC.

Hope to hear from you.
Kristi

Whatever you do, do not send Dr. Regan an email. You will never hear back. At least that has been my experience. YMMV.

How? I am only needing 1 level adr. i am fighting with BCBS of North Dakota. My surgeon spoke with an internist at BCBS and she said she is just following company policy and they will not cover. I am in the process of writting an appeal letter. I am very glad for you and think ADR is an excellent option. Any insight that could help me is greatly appreciated.

Hey Chris, just so you know, you responded to a topic from 2005. No worries here, just wanted you to know.

Pls read Laurie Todd's book; and start the appeal process one you confirm you are a solid candidate for disc replacement.