Hello all,

As we all know, insurance companies can sometimes cause enough frustration to make us forget about our physical pain. There's someone out there who's made a habit of defeating these behemoths and making them bend into submission (aka The Insurance Warrior). I recently went to speak with her and she told me one of the main things we need in any successful appeal for denial of service/payment is as many precedent cases as we can find. To get to the point, I'm setting this thread up so that there's a common place for people to come and make their information available for the community members' use in these endeavors. In other threads, people have mentioned PM'ing people that have had luck with insurance companies and I've PM'd a couple people but I'm also hoping that this new appropriately titled thread will attract some attention and can be a 1-stop info shop for people like me that are searching for this information from the community. Hopefully I can be the last person that has to work to get this information! http://adrsupport.org/groupee_common...icon_smile.gif

Who we need:
- Any ADR patients (single or multiple levels) that have had their insurance company actually cover the procedure
- Any fusion patients that have had post-op complications or fusion-related issues (i.e. adjacent discs deteriorating, etc.)
- Any ADR or fusion patients that don't fit into either of these categories (we can always use more data for cost-comparison purposes)

What we need (whatever you feel comfortable sharing):
- Name
- Insurance company
- Date(s)/location(s) of surgery
- Costs - to be used for cost-comparison to show that ADR is more cost-effective than fusion (if possible, broken down into sub-categories: hospital, drugs, physician, materials, repeat/revision surgeries, travel, etc.)
- Appeal letter if you appealed and were successful!

If you're not comfortable posting this information publicly, please just make a generic post that says "PM me for details" or something like that - so that at least we have all the people that can help with this in one place.

I'm planning on writing an appeal to BC/BS of california using the strategies outlined in Laurie Todd's book. In return for any info posted here (and this wouldn't just be helping me since everyone can see this thread), I will post my successful appeal for people to plagiarise at their heart's content (assuming I am successful http://adrsupport.org/groupee_common...icon_smile.gif - Laurie has a high confidence level in this as she's already helped someone get ADR paid for). Note that any private info I receive will not be included in the post of the successful appeal without that person's consent.

Thanks for your time and I hope this thread does what I hope it will!
-Anthony

This info would be helpful to many people.

Generally the Explanation of Benefits (EOB) pages listing what was paid are great.

It would be nice if people could scan their info and send it by email to Harrison who could then set up a section with links to those docuents for everyone going through the insurance fight!

For those who want their privacy protected, they could just cross out their name and ID number before scanning their documents!

I personally would love love love to see a few 2 level fusion EOBs, hybrid EOBs, and 2 level ADR EOBs of surgeries done in the US. But even single level fusions compared to ADR are helpful!

I'm just not sure how often those who have had surgery pay much attention to the "insurance hell" category!

Nice intent, but let's talk before "rallying the cause." I want to help, but don't want to detract from past/present/future efforts in the works. Emailing, calling is fine. http://adrsupport.org/groupee_common...n_rolleyes.gif

Anthony, LBP, let's talk soon and get the plan in place. thx for caring.

Harrison, doesn't look like you have to worry about "rallying" for a cause. He said he PM'd people with no response!

What efforts are already in place to gather EOB's of US ADR and fusion costs? As people get better and move on from this forum...we lose important contacts. Would be nice if they gave you this info before moving on so it can help others.

Some people have posted their costs in going to Germany but there's not been a lot of posting about costs of surgery in US and detailed bills after insurance has covered a procedure because we all know the discounted insurance amount is vastly different than cash payments. The actual billing statements/EOBs are much more powerful to submit to an insurer on appeal. A vague reference in a letter doesn't offer much "evidence" to fight an insurer for coverage, especially if you have an EOB of another patient with the same company!

Agreed on all fronts! But what you may be overlooking is how many times this has been attempted in an uncoordinated manner. If we work together, we may have better results. (I am leaving some of the uncomfortable outcomes associated with previous attempts to collect info from the community. We do not need to go there. More on data collection later.)

Don't forget, I regularly message (2 or 3 times anually) all the members of this community. OK, nuff said. Let's talk soon.

Whether or not Harrison has time to get involved in this request...people can still help or express their interest to help.

Those who have their Explanation of Benefits and/or other insurance/hospital/dr billing info and can fax, mail copies or scan them into pdf format.

I personally received info a while back from a couple people but more info from more sources is always helpful...especially the rare fusion patients who post here as well as more ADR patients with different insurers/hospitals and surgeons. The more examples of coverage and actual costs with US insurers...the more powerful the fight to get coverage for more people.

There is one suggestion that I have for you Harrison... couldn't you just repost AZ family guy's request at the top of the recovery section of this board? People posting in the recovery threads are more likely to have have the information he (many of us) need(s). That way people who are post surgery - will hopefully notice his thread more so than in the ins hell category.

Just an idea with minimal effort!

Excellent idea LBP!

It's important to get this request under the eyes of anybody that's had either adr or fusion - the more we can increase the exposure, the better chance we have of getting the info people need.

Harrison and I are planning on discussing this tomorrow over the phone to see where we can go with it, but your idea seems like a great start. http://adrsupport.org/groupee_common...icon_smile.gif

I've now gotten a couple responses from the PMs I sent to people and at least one of them is interested in helping with a post here once we figure the details out.

Thx guys. LBP, let me know if you'd like to join us...3-way calling is no problem.

http://adrsupport.org/groupee_common...icon_smile.gif

Hello all,

Just a quick update. Harrison and I discussed this issue over the phone and have a few ideas for how to proceed. We're ironing out the last few details and should have the plan posted here in the next few days.

Stay tuned!

Well said AZ...I am happy to aggregate information and make available to patients -- privately and securely.

: )