I would like the same information, just starting my battle soon. Just received the denial over the phone awaiting the written one. Can ayone provide a payment for a fusion (single and double) for all expenses, doctor, operating room, regular room etc.?

Judy

In my case I was battling the workers' compensation board of the state of California. I requested a utilization review and then requested a review by the state board. My case worker supported my claim and requested an expedited hearing. I sent formal letters using the format outlined in the appeals process guidebook by DePuy Spine. I also organized all of my reports, MRI's, x-rays, doctors' recommendations (I had three orthopedic surgeons supporting my ADR), and prior medical information detailing my previous good health. My surgeon also included data and articles supporting ADR and presented a case very similar to mine.

My case was sent to the state board certified orthopedic surgeon in my area of the state. Within 5 minutes of our discussion he highly recommended ADR for my case. Once I had his signed recommendation, the insurance company had to follow along and authorize my ADR. My surgery was scheduled within a week after that appointment. I posted a thread a while back regarding the appeals guidebook by DePuy Spine and other useful tips, but I don't think many people took advantage of the suggestions.

Hope this helps!

luvmysibe, I took advantage of your suggestion and received my appeals guidebook a couple days after I requested it. It has great information!

Yeah! I'm glad someone followed through with the guidebook. It is very well written and contains a ton of pertinent information.
Good luck!