Laura,
After rupturing s1/l5 in '94, (I have one leg longer than the other) it's been downhill from there. Failed back surgery syndrome and I now have 4 bad levels. The disc space at s1/l5 to very narrow and a fusion was recommended along with a 3 level adr. Enter BC who claims that adr has only been shown to be equal to but not superior than fusion and therefore is still investigation.... You know the rest.
They denied my claim and my appeal, explaining that I should then utilize the DMHC for an independant review. Of course they would do that, the DMHC has never overturned an ADR denial. Their rejection letter did not contain my complete medical history so I've appealed again.
I also found Cedars to be difficult to negotiate with. I had hoped to pay them what BC would have... but they only give a 60% discount to cash patients and charge close to $20k for the discs themselves... which is almost double the retail price????? I'm hoping the Doctor's Hospital, opening soon will be more reasonable.
Laura, I wish I had words of wisdom but in another post, I pointed out that until studies show adr's are in some way superior to fusion, the insurance companies will have a basis for denial. Why some pay and other don't... no one seems to know. Why some both authorize and deny coverage... again, it's a mystery. You would think we would have some power in numbers but...
I should be in the hospital as I write this, complaining about the pain and grateful that the surgery is behind me. Instead, I'm more despressed than ever and feeling very sorry for myself. I don't know what comes next or when. And of course, there's always Germany. But I will tell you that I intend to fight. I may consult with an attorney if my offer to split costs is also denied... or perhaps arbitration.
Have you spoken to Mark ******* at GlobalPatientNetwork.com. He can't help you with insurance problems but is very knowledgable and might be able to answer some questions for you.
I understand your plight and sympathize with your life, or lack of it. Hang in there Laura.
Dale
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