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terigrx 07-01-2009 07:30 PM

BCBS Worldwide

Wow! Reading your post gave me inspiration. We are trying to to exactly what you did, get BCBS Worldwide to pay for a single level cervical ADR in Germany through Dr. B. Do you have any additional insight? Maybe a person whom you spoke with specifically? We have been turned down 1st prior auth via Regence Blue Shield Washington and are trying the worldwide loophole (suitcase). So far BCBS world has said that this is not covered as we have already been turned down by our local carrier.

Thoughts anyone?


Deborah 07-11-2009 06:49 PM

Medicare plus normal add-on medigap policy paid for hybrid (Prodisc/fusion). :wiggle:

Harrison 07-13-2009 10:35 AM

Cervical Artificial Disc -- Friendly Insurance Companies
The following insurance carriers have issued a positive coverage decision on the Prestige Cervical Artificial Disc:

Avera Health – SD, IA, NE
BCBS Horizon – NJ
BCBS Illinois
BCBS Montana
BCBS New Mexico
BCBS Oklahoma
BCBS South Carolina
BCBS Texas
Brown and Toland IPA – CA
BSBS North Dakota
Builders Insurance Company – NV
Community Care of OK – OK
Cox Health-MO
Dean Health Plan-WI
Employers Insurance of Nevada – NV
Gunderson – Lutheran Health Plan – WI
Highmark BCBS – PA, WV
Lovelace Health Plan – NM
Medical Mutual - OH
Montana State Employee Fund-MT
Motion Picture Association-CA
ODS Health Plan
Pacific Source-OR
Physicians Plus – WI
Premera WA, AK (also administrators for LifeWise AZ, OR)
Priority Health of Western MI – MI
Public Employees Benefit Program – NV
Public Employees Health Plan of Utah – UT
SelectHealth – UT
Willis-Knighton Health Plus – LA
Writer’s Guild-CA

Source: 1-800-446-1234 or visit Original article here.

nanfromsactown 07-15-2009 04:39 PM


Originally Posted by Deborah (Post 83606)
Medicare plus normal add-on medigap policy paid for hybrid (Prodisc/fusion). :wiggle:

Hi Deborah,

Was this surgery done in the US or abroad?


Deborah 07-15-2009 10:00 PM

The surgery was done here with US doctors at UCSF. And it went wonderfully, surgery 3/3/09 and no meds today (after 8 years of high dose oxycontin and the last two bedridden with same meds). Very impressed with the docs and convenience for us.

His only real struggle is getting back into life - fx, actually feeling indigestion after years of masking normal feelings, and rebuilding core and stamina which both have a long way to go. (All the result of inactivity, not the lumbar problem.)

LaminectoMan 02-26-2010 05:40 PM

Hello Harrison, First I am not sure how you always 'tirelessly' help others. I am amazed at the good you work here. Enough shmoozing. I have a favor to ask, I was going to ask someone if they know of doctors and insurance companies in the U.S. that will perform ADR and realize that is a much repetative question. I saw this link, it took me to a PDF file that showed AETNA with a ruling that says the 'do?" pay, but the link was no good.

I work for the Boeing Co. and hold Aetna BC BS, I wonder if you may know anything about this in the Pacific NW / Aetna etc?

Thank you very much

Harrison 02-26-2010 07:40 PM

Hey Lammie, thx for your kind words and also letting me know about the link. We've had several folks from Boeing pass through here (one donated his super-duper home computer system to this foundation) and are good people and may be able to help you. Also, you and I can talk offline (pls email pr PM me your # and I'll call you in the next 3-5 days).

In the meantime, if you search the Aetna site, you'll find some helpful information:

Clinical Policy Bulletin:
Intervertebral Disc Prostheses

And others as well:

Spinal Surgery: Laminectomy and Fusion
Aetna considers cervical laminectomy (may be combined with an anterior approach) medically necessary for individuals with a herniated disc when all of the following criteria are met:

Back Pain - Invasive Procedures
Aetna considers any of the following injections or procedures medically necessary for the treatment of back pain; provided, however, that only one invasive modality or procedure will be considered medically necessary at a time.

Frankg 06-13-2010 05:50 PM

Are you saying that in 2006 aetna paid for you to have a 3-level Cervical ADR?

Frankg 06-15-2010 01:15 AM

please clarify where this discussion goes..

I noticed that the popular question "who is paying for adr?" is in the forum Insurance Hell and The Big File. Shouldn't that discussion be taking place in one forum only?

Jmbeam 06-28-2010 10:48 AM

I see that Aetna has a good track record in covering ADR surgeries. Is it possible for anyone to join this company? I realize the premiums will be high but if they cover ADR it will more than pay off.

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