Hi. I might need, pending a discogram and more facet injections, at least a fusion at L5-S1 and ADR at L4-L5 - a place that makes me nervous in case of trouble.

At one esteemed LA spine surgeon's office, the insurance person told me that with my coverage of BC of CA and BC/BS of NY (weak policy), that if I bill only for the one level fusion, they can deny this if they find out I had an ADR paid out-of-pocket. In the States, even this is expensive. I could alternatively try to get the ADR hybrid in full approved which of course would be a "no".

So is this how things are? That a person with a hybrid must pay for all levels out-of-pocket as an ADR at one level can preclude payment at all? I find this to be shocking.

Europe's to expensive for me. I know there's Pimenta in Brazil but don't know about his facilities, exchange rate - or anything other than he's respected. I think they ignored one person's attempts to contact them.

Anyhow, I sound like I'm complaining.

Just checking if people are encouraged to pay out of pocket for ADR/fusion hybrids, in toto.

Thanks and be well. - Allan

Allan, As you know I"m an Aussie so can't help you with the insurance part of things.
As a guide though I can tell you my health insurance fund paid out over $42,000 for my hybrid surgery 2 years ago. Interestingly, I've just looked up my recent 2 level fusion payout and it was "only" $25,000. Big difference!
Cathy
N.B. the exchange rate right now is almost equal.

I did pay for my entire surgery out of pocket. My lawsuit against the homeowner whose dog took me out covered it and then BC/BS of Michigan also reversed their denial and covered my surgery. I was thrilled.

Terry Newton

Thank you for your replies. Cathy, great that you were covered, and Terry, glad you won the battle (but how?). Looks like it took a "pound of flesh" to pay for the out-of-pocket costs and that nasty looking pitbull in our building's looking better.

Heal well people. - ans

Allan,

If you find an answer to get insurance to cover ADR, please tell everyone. I have Blue Cross of California and they are some unprintable name.
I can't believe insurance companies are so stupid.
I like my ADR and yet I continue to fight BC and tackle workers comp also.
I keep thinking what would have happened if BC just approved the ADR when we asked for it. I would probably still be employed.
A lot of times I have just wanted to throw up my hands into the air and say, "who cares. You bleeping Blue Cross."
With wc, I have to prove that lifting patients and heavy stuff, caused my DDD. To me it is a no-brainer, but I am the one who was going to massage therapy because my lower back was hurting more and more. I didn't have a clue about DDD.
I feel like nobody is cutting ADR patients a break. I mean nobody from the private insurance companies (other than Aetna, Cigna, Kaiser). Like I always say, what use is insurance if you cannot use it?
I would fight for every little thing. I don't think insurance companies can deny care because you self-paid for an ADR.
I think that is a scare tactic, but ask someone more knowledgible in insurance law.
Again, my two cents--for whatever it is worth.

Kimmers

Kimmers: I agree with you and thanks for your response. I note that you, a nurse, got denied 3X. Now this is discouraging and if I do go for it, we should get a team to work together and fight. (I used to be a researcher-type). I take it that you used The Insurance Warrior's advice, etc.

I admire your guts and perseverance. Anyone know a person in network news who could cover your story? Shame on them - or, shame them.

Allan

My insurance company paid for the fusion and hospital stay and all. I just wrote a check to my doctor for the charite fee, 20k for two, and had to pay the out of network costs for the rest of the stuff.

Juli, I"m glad you are feeling so well.

Did Bitan's people even mention that you were to get an ADR or did they mention only for the fusion part.

If you wish to keep this private, then please PM me. Btw, what insurance company did you have?

Thank you for your time. I hope that you've recovered most of your life back!

W/Regards, Allan

Hi ans,

I believe they did submit the whole thing though we knew upfront that they would most likely not pay for the discs. I have United Health Care.

Thanks, I feel fantastic, best money I ever spent.
Hope things work out for you.

Juli

Allan,

Has Blue Cross budged?
I am so entirely pissed off at them. I got a denial the other day for a CT exam I had at my sinus doctor's office. Now, these exams are pre-approved before they are done.
There is no way I will pay for this.

Just another example of Blue Cross's idiocy.

I am praying that Anthem/Blue Cross goes out of business. It would be just desserts. I can tell you I saw recently in the newspaper that BC/Anthem was fined 11.3 million for approving surgical procedures and then rescinding the policies of people after the surgery was done.

And here we are looking at a $63,000 hospital bill for my ADR surgery. They have quite a racket going on, denying ADR.
I learned a few things about appeals so I can help, but you cannot reason with BC. They are like a dictatorship.
I am not kidding when I say they are evil.

Sure, I studied Laura's book and e-mailed her for advice.
All in all, I would have ADR over fusion and am pleased with the ADR results so far even if it is a roller coaster ride.