Insurance Paid - Dr. Clavel 2 level ADR
 

Hi all,

Its wonderful to have my life back! And I am excited to report that BCBS did PAY "out of network", which is 60% of the cost of my surgery with Dr. Clavel.:clap::clap:
I honestly have no idea why or what we did any differently than anyone else. Possibly it was the documentation? or the fact that I have a Worldwide Blue rider on my policy.

We sent our documentation to Worldwide Blue the last week of Jan. 2013, by Fed EX with a signature required. We included a cover letter detailing my injury and the course of medical treatment and physical therapy that I partook in for the 3 1/2 years after the injury. In the letter we explained that the interim treatments were not working and that I along with my local neurosurgeon began looking for a solution. My Dr. Neuro's final diagnosis was for a two disc replacement (he uses the Pro-disc).
We explained that it was determined that a 2 disc replacement in a SINGLE surgery was best for my situation and that we also had determined that the M6 was best suited for me. (this was based upon our research, my Dr. had never heard of the M-6) We even stated that the M6 had not yet received FDA authorization, but was used successfully and routinely in Europe - specifically Spain- at a fraction of the cost for a single disc replacement in the USA.
We included detailed documentation of everything including a Letter of Medical Necessity from my local Neurosurgeon, copy of the auto accident report which was the cause of my neck problem, copies of paid invoices from BSC, detailed itemization of the total charges related to the surgery, proof of payment, medical reports, copies of x-rays, etc....
It also should be noted that I had 2 plus years of physical therapy, pain management, injections, chiropractor and had exhausted every conceivable alternative to surgery.

We are still in shock - can't believe that we were paid! It should be noted that it took more than 3 months for us to receive the check.

Hopefully, we will see more insurance companies pay for this in the future!

I do not know why they paid or what we did any differently from any one else who has attempted to be reimbursed by their insurance company so I really do not have answers. I will say KEEP DETAILED RECORDS OF EVERYTHING! I even requested copies of my doctor's notes for every visit (do this at the time of the visit as you check out) Also request copies of the radiologists reports for every x-ray, MRI, Myelogram, etc... I have a stack of documentation several inches thick. So keep copies of EVERYthing including hotel bills, dining, travel expenses, EVERYthing!

Hope this helps!

So happy for you!! I wish you a speedy and successful recovery. This is a very positive thing; having your insurance pay for what they are supose to!

Tammi :jacks:

Confused, I don't know what to say!?!? Congratulations!!!

That is GREAT news!

Wow, good for you! You're right in that the more receipts and documentation you have the better your chances of getting money for anything. Very hard when you are in pain though to think of everything so well done you.

My wonderful spouse deserves most of the credit! He is great at keeping records and he encouraged me to keep a diary, notes and to get documentation from the doctors. But I really believe the documentation & having it organized probably had something to do with insurance paying... On that note I got my annual increase - UGH! It goes up 15 - 20% annually since the new Health Care Bill was passed.

I had a simmular experiance with BCBS also. I submited it to Blue Card int. and it was approved and I was given 80% back in two checks fro some reason but hey its all good when you get money back and it also took about 6mo to get it. I thought for sure I wasent going to see a thing.:clap:

Good for Both of you.
 

Glad to see that BCBS is now paying, if they want to stay in business, they have to go back to the books and realize, how to make money, how to pay for the injuries and make money while doing this or get out of the business altogether.

I have three more tests to take, in the coming weeks, all of it will be documented, as is everything else, even pain medication.

Good to see that the M6 really works, M6L, I emailed someone that had one put in at the L5-S1, four years ago, it really works, recommends it.

Again,

Glad for you Folks, still amazes me, that the FDA won't approve the M6.

Jerry

first test
 

First test this Tuesday, Facet block, don't like the idea of a needle in the back, but they will numb the site first.

Probably will feel good afterward.

J

I received a letter of non-certification from the "Medical Cost Management Corporation" for BCBS. I can't believe that they won't even consider fusion. Their "Principle Reason" is that my pain should be controlled with lifestyle changes and conservative treatment. They really want you to jump through hoops. Well since I'm the queen of record keeping, they will receive a 5 page letter outlining my "conservative" treatment along with doctors notes and results for the past 5 years. THIS THEY ALREADY HAVE! For goodness sake, BCBS paid for it! I have always been a firm believer that you never give up. These organizations rely on people throwing their hands in the air and saying, "oh well." Please let me know if there is anything else I can request or document while in Germany. I don't want to leave Dr. Bierstedt's office until I have whatever documentation, coding, etc. that can at least give me some chance of reimbursement; minuscule as it may be. I am elated to hear that many of you are being reimbursed, especially for multi-level. I am hopeful too. Congratulations for breaking the boundaries so the rest of us may pass!
My sincerest gratitude :)