Judy,
I'd be very wary of the legalities of your insurance company refusing to put something in writing. You should document every conversation as to date, time, the reps name and of course, the content. You should also insist on speaking to a supervisor to confirm this refusal so as to avoid any possible misunderstanding or their denial that the conversation ever took place.
As far as costs, J&J sells the Charite disc for $11,500, Dr. Regan in Los Angeles charges $7,500 for the first implantation and half that for additional levels. I do not know the specific cost for a fusion. The assistant surgeon is about $3,000 and the anesthesiologist - about $1,500. Hospital charges which include OR time, daily room rates and meds are additional. For a 3 level plus 1 fusion, Cedars wanted $78,000 up front, for a 3 day stay, and the Doctor's Hospital wanted $90,000. From that, I would think you'd simply subtract one level disc ($11,500) to get your cost. In Germany, my costs which include airfare, hotels and meals will be less than half.
BC told me that they do not pay for out of the country medical care unless an emergency. They also denied my U.S. adr, and would not separate the fusion and adr unless done in 2 surgeries. I am going to Germany in December and will submit all my bills to BC for reimbursement... and will litigate if necessary. I cannot tell you what the outcome will be.
If you get no satisfaction from your state ins. commissioner, you will probably need legal representation... and they will need your documentation of phone calls.
I wish you a lot of luck!
Now that your 1 year anniversary is approaching, how are you doing? Is your pain gone... has your life improved?
Dale
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