[Nairek]

[QUOTE]Originally posted by LBP:
wasn't Empire one of the few BCBS that had been covering ADR???? am I confusing it with another BCBS? Are you trying to get a one level Charite or ProDisc??

Sorry it took so long to get back to you. I had to study for a test in Human Biology & I crashed before I could get on the computer to respond. I am trying to get a 1 level Charite at L5-S1. Some Empire Blue Cross plans will pay for this surgery & most will not. I know that Horizon BC/BS of New Jersey released a statement that they will pay for it. However, Empire BC/BS of New York will not cover it. I tried to get pre-certified thru BC/BS & they gave me the "it's experimental" fluff.

In my research, I came across a notice from Aetna which states that ADR surgery is deemed medically necessary & it would be covered under their plan. The catch is, the decision to cover this procedure is up to each individual plan. In other words, 1 Aetna plan would pay for it whereas another Aetna plan would not. Another interesting tidbit was that any of these plans could reverse their decision at any time. Say if Plan A covered it as of January 1, 2006, they could then decide that as of November 1, 2006 that they would no longer cover the procedure.

It is my understanding that Empire BC/BS has covered 1 ADR surgery in New York based upon individual consideration. I would love to know what type of documentation this person had in order to get the approval. I'm hoping that what I sent them will be enough to open their eyes & rule in my favor.