I'm going to be getting the Charite at L4-5 by Dr. Yue, hopefully in October. I'm waiting for his secretary to give me the exact date. I have Anthem BCBS out of CT and have decided to get the procedure while I'm beginning the appeals process. My question is, Has anyone been reimbursed for the procedure from winning on the appeals after they paid for the surgery out of pocket? I'm paying about 32,000 upfront and hope that there is a chance I could be reimbursed in the months while I'm recovering.

Please let me know.

I think you stand a very good chance of getting repaid. I paid up front because I thought my Ins. rider excluded any thing to do with my back. I found out it only disallowed outpatient procedured. Look at your contract's pre-certification requirement planned days stayed in the hospital. Don't go over that. Try to get the hospital and doctor to submit the claims for you. If they don't want to because of a "package price" then ask for an itemized bill from both and do it yourself. The ins may balk but they have no legal reason to deny repayment. I feel the worst case is that you will need a strongly worded letter from an lawyer to to them and your state's insurance commisioner get them to pay.

Good luck and see you on the other side

Pat

The only reason why my insurance won't pay is because of the experimental/investigational part. Hopefully I will be able to prove to them during my recovery that it isn't experimental or investigational. I'm 22 years old and no doctor thinks I should get a fusion.

Although I'm no expert, I wouldn't plan on being reimbursed later if the reason why your insurance company is denying payment because of the experimental/investigational clause. That's why most of us have been denied. I hired an attorney, did all of the appeals. My case went to an out-of-state ombudsman, and a panel of "experts". One of the panel of 3 said my insurance company should pay for it, the other two said that it was investigational/experimental, so the insurance company isn't paying. Majority rules. Lawyers and the Insurance Commissioner imo have no influence or say on any of it.

I live in the great state of NY, and I have been told by everyone I've asked (including two of the original doctors in the trials and several representatives from DuPuy) that there is not a health insurer in the state that is paying for it.