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

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

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

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?

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

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

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

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:

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.

yes I was covered 100 percent also dr clavel was in network so was hospital oh I also have a ppo plan

Hey Jason,
Congrats on reimbursement and hopefully a succesful surgery.

I have my documents in right now and awaiting there determination. Filed exaclty as you and was toldthey were doing an audit on the claim last week for my double cervical in June. News to come hopefully.

Just got back last night from a double lumbar done one on December 18 so this should get real interesting.

Can you tell me where you found that Clavel was in Network?

I would appreciate it. Thanks Frank

yea im 3 months post op 2 level lumbar, I believe Yolanda told me over the phone when I called up I asked if they accepted my insurance and also if the hospital did she said yes

Frankly,
I found them listed on the WORLDWIDE BLUE website.
Good luck!:clap:

Well All,

Not sure if you had seen my post but I too got reimbursed 100% for my Cervical 2 level.

Just about to put in for the Lumbar claim.
I think it has alot to do with or all to do with Quiron Hospital is a preferred provider for BCBS WW and considered in network. I think what is happening is that the ice has been cracked and there is recognition that Clavel is accepted as in network. I have also seen more people going to Germany getting paid as well.
It is sad however that as US citizens we cannot without alot of stink have choices. Remember we still all paid a bunch of duckets to fly and hotel as well.
Lumbar was no joke so visiting really wasn't any picknick walking around in Spain. The other unfortunate thing is the really calous nature of many (not all) of our Doctors here. Hold on this ride is gonna be rough cause its gonna get worse.

Ill keep up to date on the lumbar claim. Go's in tomorrow.:wiggle:

F

Frank,


BlueCard WW actually called Quiron to get blood tests and medical reports directly. I was not aware they would do that. I think they were trying to expedite the claim. My info could not be released since I did not sign any release forms. I told Yolanda to tell them if they called back that I would be submitting the info personally. I could have had it done directly, but I wanted to insure getting copies of all paperwork exchanged for my records. How long did you wait for the email with the itemized billing?

B,

First, I hope you are doing well!!!
Took about 3-4 weeks from memory. It takes time for them to get it all put together unfortunately and then it needs to be put in english. Make sure you also get a Letter of medical necessity.
It sounds like your gonna be OK with being reimbursed. The only costs they took out were Hotel and the added insurance if you bought it. I was only 200$ copay. Dot your I's and cross T's. My only concern for you is that I think you said you have a PPO. It might cut it but then again others it did not.

Frank

My plan is a PPO for care within the United States. Not sure how they handle claims outside the U S. I'm gonna push for in-network benefits citing Quiron being listed as a preferred provider. My insurance covers at 90% for in-network....out of network covers at 70%. Even if I got reimbursed at an out of network rate, it's better than nothing at all. I'm hoping me contacting them ahead of surgery helps. I believe poster Jasonhhh also had PPO with BCBS.. he got 100%. It depends how your policy reads. All I know is I verified coverage with home base and BCWW. We'll see. What type of BCBS policy u have?

I contacted BlueCard Worldwide. They said I was covered, as did my home policy...I verified that nonemergency care was covered and I w as planning spinal surgery.. Some people depending on policy are only covered for emergency care or doctor visits when traveling, not scheduled surgeries. It's important for BCBS members verify what is covered before planning expensive surgeries. I have not had any reps say I had no coverage. They did say I may only get a 70% rate. Fingers will be crossed when I mail the paperwork.

Hi all!
I love hearing that some are getting 100% reimbursed! Should I request my 40%? LoL just kidding, I was thrilled to get the 69% paid for.

News about me---still feeling awesome! Just got back from hiking and some very junior rock climbing in AZ. My disc held up well and I had no pain! I count my blessings everyday for the M6 and Dr. Clavel. I'm doing Pilates 2 times a week, walking almost daily with some jogging mixed in. I feel better than I have felt in years and since my injury was accident related I take NOTHING for granted. I hope everyone else is doing well too!

Doing Terrible
 

Mean that in a good way, if that is possible.

Please call (804)673-1177, wait and press (2). (BCBS International)

Tell them if they want to keep people enrolled, they need to approve these surgeries, until the Communist FDA approves this in the USA.

(sorry for the rant, but people need to have this option, this M6 is an American Product, and the surgeons in Europe, have implanted this for SEVEN Years, this is beyond ridiculous)

Until, then, I am very glad you are doing well.

God Bless,

As far as I can see, there is more than just the FDA at work here:

http://www.cafc.uscourts.gov/images/...-25-2013.1.PDF

That took awhile
 

That was twisted, took me awhile to read that...,

I will have to go over that again?

For Sure DePUy, (Johnson and Johnson) has a LOT of money, and as you can see, will tie this up in court as long as necessary, to put SK out of business.

Sounds to me, that J&J is stealing the technology.

We will see.

For sure, for now, if you want to have an M6, you will have to go out of Conus.

Jerry, no way I am reading that entire lawsuit todday but for sure J&J has deep pockets. I cannot help but wonder. if there is a patent infringement, why is the M6 allowed in Germany, Spain, UK etc. J&J could also persue Spinal Kinetics in other countries. Who is right and who is wrong...? In the meantime it seems to be tied up in the court system; so yes, overseas is the only option for now.

Mike C
 

Yea that took awhile to read.

I am not a laywer, and we do not have all the information.

The patent was applied for, by Spinal Kinetics, in 2002/3 and over the years, have refined the final design, I guess that decided the strands would better fit into a slot, or hole, than try to land the strands in a groove...,

Go figure, this is what they are arguing about, seems J&J has a similar product in some stage of design, and their product has the holes, also, so they are arguing that SK cannot use this design.

If SK is arguing this in California, this may be their biggest mistake, they need to take it somewhere that has a Judge and Jury, that will listen to common sense, not money.

That is my take.

:uhoh:

Isnt this old news?
Wasnt this decided last year?
IIRC i read this in the news awhile back.

Decided
 

pittpete,
I read the pdf and this sounded really ridiculous, like politicians, arguing how best to steal your money.

This what big companies do best, they destroy the process, buy politicians, and work the system.

The M6 should have been available a LONG time ago.

This patent process, once you apply and receive your patent, and approved idea, if you refine the process, you should be able to move forward with your product, this seems to NOT be the case.

This is a long read, 32 pages, but the end result, was there needed to be 'another' case, which is what J&J wanted, to tie this up in court to keep SK from moving forward with their product.

My guess is that SK, will just move from the USA.