Insurance reimbursement
 

After almost a year and half of researching to figure out what was wrong with me and finding the best way to fix it, I am 99% sure I will be seeing Dr. Clavel very soon for a 3 level Cervical ADR.
I have researched this forum deeply trying to get the best answer just to remain confused as to the correct procedure and order of achieving a Reimbusement from my Insurance Company.
I have Blue Cross
Here is the question:
1. I have read people just going ahead and having the surgery, then sending the surgery info in to Blue Cross for reimbursement.
2. I have read also that people have gone the old preapproval route, sending their information in before.

I have already been through the appeals process for a one level all the way to the external review level, where I backed out because I have a multiple level problem.
Any assistance, guidance or oppinions will be soooo appreciated.
Thank you

Hello Iron,

I was one of the lucky ones who DID get reimbursement from BCBS. I did not get preapproval from my insurance because they don't like the idea that you will leave the states (in my case) to seek healthcare anywhere else; especially a multi-level which was not FDA approved here. I could not have ADR in 2013 due to the multi-level/adjacent to a fusion issue. My only choice was to choose a surgeon elsewhere; otherwise endure multi-level fusion and a restricted lifestyle.
I did go ahead with the surgery anticipating that it would be an out of pocket expense - and yes....I went through my savings, borrowed some money, and sadly sold off some personal possessions. However, my happy thought through all of this was that I would get my life back and enjoy it (priceless!)

My BCBS is through a Chicago Union. I collected all receipts which included a detailed financial statement (in euros and US $) from the surgeon, hospital, and rehab center. I also requested a statement of diagnosis from my surgeon with his surgical notes and opinions. I submitted everything to the BCBS Worldwide network (part of my plan), but they didn't know what to do with it (???) I resubmitted everything directly to our contracted carrier's office. They submitted everything and it took almost a year from the date of surgery to the date I received my check. They covered everything - 100%. How could they not? My actual surgery was a pittance charge for what would have been charged for the surgical intervention here in the states, plus I have a more positive outcome that would not require additional surgery in the future....Saving THEM money! I made sure that I included a letter outlining all of the pre surgical requirements that needed to be fulfilled (therapies, injections, and any other non invasive interventions).

All non-surgical/non-insurance related expenses became a medical tax deduction. My transportation, additional hotel charges, rental car, etc. was submitted and I was able to "eek" back a healthier return too.

I believe persistance is the key with dealing with insurance companies. All too many times they deny claims for absurd reasons - or they made an error. Many people don't bother to question the denial or they make a phone call, but don't get the response they want. I DO! I believe it takes at least 3 phone calls to clear up one little error. Do not give up - perseverance is the key to success. My submission to BCBS was at least 3-4" thick of paperwork - I think I may have scared them away (someone has to read it all).

Good luck to you.
LauraB

File and Appeal
 

File for reimbursement, they will haggle and not want to pay, but APPEAL, if they do not the first time.

Make sure you give a detailed history and tell them that this was NOT elective.

Did get some reimbursement.

But I had to fight, call and APPEAL.

This is ALL the more reason for 100% REPEAL of this Monstrosity, they call the ACA.
TORT Reform and 50 state access for ALL insurance.

Best of luck.

Hi Laura, i hope u are doing well and living pain free. Im in the middle of an appeal for hybrid coverage here in the states even though i dont really want that. Im wondering how you did this. Were u in the appeals process? Did u talk to them first and try to get a reimbursement agreement before u went over there. Im thinking of trying to convince insurance to pay for me to go over there and save them money.

Also, was it "blue card world wide" i have bcbs of nc with the blue card world wide coverage.

I haven't seen Laura around since she posted on my thread. Take a look at her two posts here: https://www.adrsupport.org/forums/f6...tml#post109793

If these don't answer your questions, I suggest you send her a PM.

Wishing you wellness.

Document EVERYTHING
 

...and go straight to them, BCBS will reimburse.

what she said
 

I agree with Laura B.

Sorry guys. I haven't been around too much lately only due to a job change and dealing with my mom's cancer.

I went with the BCBS Worldwide and found myself moving in circles. I eventually contacted local office "Union," and explained the situation. I copied and resent my file - I think the size of it scared them into submission. They took it over and paid.

From my perspective, if I was traveling and had this issue, I would be treated overseas using the "best practice" available. In Germany, they have been performing this surgery, successfully, for over 20+ years. That doesn't seem like "exploratory" or "experimental" procedures. This is what I made clear in my explanation of the diagnosis and treatment. It also was important to show that you have exhausted all forms of "non-invasive" pre-surgical protocol procedures prior to surgery; being your last resort. I included a timeline history of cervical injections, therapies, and diagnostic testing.

Laura, I'm so sorry to hear about your Mom's cancer. I wish you both wellness and hope for her full recovery. I know it's difficult because I helped both my parents through their illnesses and end of lives. I'm so sorry you and your family are facing these challenges. Sending prayers.