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Search: Posts Made By: sfmcfar
Forum: The Big File 12-22-2005, 01:15 PM
Replies: 28
Views: 18,630
Posted By sfmcfar
Age 38 - was offered a free freezer if I moved it...

Age 38 - was offered a free freezer if I moved it myself. What a mistake that was. http://adrsupport.org/groupee_common/emoticons/icon_wink.gif
Forum: The Big File 11-08-2005, 05:41 PM
Replies: 5
Views: 9,108
Posted By sfmcfar
Hi, UHC approved my upcoming one-level ADR,...

Hi,

UHC approved my upcoming one-level ADR, but only because they were forced to. MD-IPA, which is operated by UHC, had to cover mine since I'm a member of a Federal Employee health plan and they...
Forum: The Big File 08-24-2005, 12:38 PM
Replies: 8
Views: 10,463
Posted By sfmcfar
In my case, there are regulations that apply to...

In my case, there are regulations that apply to individuals that are covered under the Federal Employee Health Benefits plan, so they may not be applicable in your case. Simply put, FEHB carriers...
Forum: The Big File 08-23-2005, 10:03 PM
Replies: 8
Views: 10,463
Posted By sfmcfar
After two denials from MD-IPA (owned by UHC), the...

After two denials from MD-IPA (owned by UHC), the US Office of Personnel Management - the final arbiter for patients covered under Federal Employee health plans - determined that MD-IPA did not apply...
Forum: The Big File 07-18-2005, 11:03 AM
Replies: 11
Views: 9,812
Posted By sfmcfar
Has anybody read the editorials in the July Spine...

Has anybody read the editorials in the July Spine entitled "Editorial Response to Parts 1 and 2 of the FDA IDE Study of Lumbar Total Disc Replacement With the Charite[TM] Artificial Disc Vs. Lumbar...
Forum: The Big File 06-28-2005, 03:08 PM
Replies: 9
Views: 7,718
Posted By sfmcfar
The only suggestion I have, if you haven't done...

The only suggestion I have, if you haven't done it before, is to attempt to refute your health plan's definition of "experimental." If you can show that ADR does not meet their own definition of...
Forum: The Big File 06-24-2005, 03:33 PM
Replies: 24
Views: 24,501
Posted By sfmcfar
Kristi/Kat, MAMSI, which is owned by UHC,...

Kristi/Kat,

MAMSI, which is owned by UHC, denied my appeal, and I'm pretty sure they never even bothered to read it. In my appeal I told MAMSI that Federal regulations prevented them from...
Forum: The Big File 06-17-2005, 10:10 AM
Replies: 9
Views: 7,888
Posted By sfmcfar
Interesting. I've tried for over a month to get...

Interesting. I've tried for over a month to get a simple question answered by my surgeon. Have left a least a dozen phone messages with his secretary. Nothing.
Forum: The Big File 06-16-2005, 07:33 PM
Replies: 93
Views: 86,593
Posted By sfmcfar
FWIW... My doc has told me that UHC has been...

FWIW...

My doc has told me that UHC has been the worst when it comes to approving ADR. I have MAMSI, which is owned by UHC, and I don't believe they even looked at my appeal before they denied...
Forum: The Big File 06-10-2005, 10:41 AM
Replies: 5
Views: 5,690
Posted By sfmcfar
Rein, You may be right. She was definitely...

Rein,

You may be right. She was definitely not hitting on all cylinders. http://adrsupport.org/groupee_common/emoticons/icon_wink.gif The thing that *really* gets me is that MAMSI isn't...
Forum: The Big File 06-09-2005, 03:19 PM
Replies: 5
Views: 5,690
Posted By sfmcfar
Well, the saga continues. My appeal was denied...

Well, the saga continues. My appeal was denied by MAMSI, again using the "experimental" label. I haven't seen their formal response yet, but I received a "courtesy" call from their appeal "auditor"...
Forum: The Big File 05-19-2005, 08:19 PM
Replies: 4
Views: 8,466
Posted By sfmcfar
It seems to me, as I may have mentioned before,...

It seems to me, as I may have mentioned before, that the thing to do is to get a law passed that prohibits carriers from claiming something that's been FDA approved is "experimental." It seems to me...
Forum: The Big File 05-17-2005, 09:21 PM
Replies: 3
Views: 5,814
Posted By sfmcfar
I received a copy of my radiologist's report...

I received a copy of my radiologist's report today to use for my appeal. The goal of my appeal is to demonstrate that I meet the indications as stated by the FDA, and one of those conditions is...
Forum: The Big File 05-16-2005, 05:34 PM
Replies: 6
Views: 5,264
Posted By sfmcfar
> This country is in bad need of Health Insurance...

> This country is in bad need of Health Insurance reform....

I'd be satisfied with a bill that would prevent insurance companies from being able to classify an FDA-approved product as "unproven"...
Forum: The Big File 05-16-2005, 12:05 PM
Replies: 6
Views: 5,264
Posted By sfmcfar
Don't mean to rain on your parade, but I've been...

Don't mean to rain on your parade, but I've been told that UHC has yet to approve ANY ADR. I sincerely hope you're successful, because my insurance company (MAMSI) is a subsidiary of UHC, and is...
Forum: The Big File 05-11-2005, 07:34 PM
Replies: 5
Views: 6,918
Posted By sfmcfar
To my surprise (well, maybe not) MAMSI denied my...

To my surprise (well, maybe not) MAMSI denied my coverage yesterday for a one-level ADR at L5-S1, stating that it's "unproven/experimental." They apparently have chosen to ignore the OPM regulation...
Forum: The Big File 04-28-2005, 12:16 PM
Replies: 15
Views: 11,775
Posted By sfmcfar
Forgot to mention that my original question has...

Forgot to mention that my original question has become somewhat moot. Since I'm covered under the Federal Employee Health Benefits (FEHB) Plan, my insurance carrier, by law, cannot declare anything...
Forum: The Big File 04-28-2005, 12:11 PM
Replies: 15
Views: 11,775
Posted By sfmcfar
Hi, In answer to Brady's question as to...

Hi,

In answer to Brady's question as to where I am in the authorization process is: I don't know. http://adrsupport.org/groupee_common/emoticons/icon_wink.gif I *think* that my...
Forum: The Big File 04-24-2005, 09:55 PM
Replies: 6
Views: 8,021
Posted By sfmcfar
Kim, make the sure the plan documentation...

Kim,

make the sure the plan documentation doesn't have the definition of investigational and experimental in it already - I know the my MAMSI plan has it listed in their defintions. Also search...
Forum: The Big File 04-24-2005, 07:48 PM
Replies: 6
Views: 8,021
Posted By sfmcfar
Kim, I'm new to the appeal procedure - I'm...

Kim,

I'm new to the appeal procedure - I'm hoping I won't have to appeal, but I'm already getting my guns lined up - but here are my thoughts.

First, keep your letter professional. The less...
Forum: The Big File 04-23-2005, 09:49 AM
Replies: 5
Views: 8,183
Posted By sfmcfar
Robin, Here are the facts, based on the FEHB...

Robin,

Here are the facts, based on the FEHB letter I posted. If your insurance is held through the FEHB program, they cannot classify anything that has been FDA approved as "experimental" or...
Forum: The Big File 04-22-2005, 07:55 PM
Replies: 7
Views: 9,975
Posted By sfmcfar
Hi, Sorry you had problems with McAfee's...

Hi,

Sorry you had problems with McAfee's office. I have a feeling they're beaten down over the insuarnce fights and are tired of it, and I can't really blame them. As far as whose responsibility...
Forum: The Big File 04-22-2005, 06:48 PM
Replies: 5
Views: 8,183
Posted By sfmcfar
Hi all, I don't know if this is known by the...

Hi all,

I don't know if this is known by the group or not, but anyone covered under the Federal Employee Health Benefits Plan (FEHB) cannot be denied coverage for the Charite ADR, provided it...
Forum: The Big File 04-22-2005, 03:45 PM
Replies: 15
Views: 11,775
Posted By sfmcfar
Cathy, Thanks for posting - but not for the...

Cathy,

Thanks for posting - but not for the bad news. http://adrsupport.org/groupee_common/emoticons/icon_smile.gif
Forum: The Big File 04-22-2005, 02:42 PM
Replies: 15
Views: 11,775
Posted By sfmcfar
One more question for all of you - it seems like...

One more question for all of you - it seems like most of the folks on this board don't fit the FDA approved criteria - multiple levels, wrong levels, etc, etc. I, on the other hand, meet the FDA...
Showing results 1 to 25 of 29

 

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