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Old 03-21-2007, 09:18 PM
Abbe Abbe is offline
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Join Date: Feb 2007
Posts: 61
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Boy couldn't we all use some good news! I am on my second denial and if that weren't all I have decided to go back to Dr. Delamarter and stop going to Dr. Williams. I had asked Dr. Williams how many disc replacements he had done and he told me 15. That was too few in my mind. In addition his office never seems to get back to you so I had to make an appointment and go see him just to discuss being denied and what our next plan of attack should be. He had no idea that I had been denied the first time because he was never given my file to write to the insurance company. The gal who schedules the surgeries just sent in to the insurance co. and never got a letter of necessity from him. Then it was submitted incorrectly anyway. So, now that I am educating myself on this whole process I have found that Prodisc has an advocacy program for patients and they will work on your behalf to try and get the insurance company to approve the procedure. You can go onto Prodisc's web sight and get the phone number and contact them. They will need to be able to get your medical records so they can act as your agent so to speak but they have been very helpful and as with anything you have to be persistant. I did find out today that my insurance Co. asked for some more documentation so, I guess that this is better than another denial. My plan "C" is to use a version of the letter Paulette posted here and I am asking for the articles she mentions as well.

Abbe
__________________
Water ski accident 86'
Chiropractic& PT Pain meds
Discectomy Laminectomy
L5 S1 Partially sacralized
97' epidural injections
L3 L4 ruptured and torn
L4 L5 Almost no disk height left along with osteophytes
Left leg pain and tingling going down back of leg into heel & foot
3 appeals with BCBS no success Lost insurance.
Kaiser Permanente
L3-L4, L4-L5 Prodisc 9/18/09
C5-6 & C6-7 ruptured and looking at hybrid surgery fusion & Prestige ADR
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