[tisury]

This is a good topic with some real informative posts. I have learned alot that may be useful in the near future. Oddly enough, my first ADR in Feb 2004 went through with no problem - fully covered. I still haven't figured that one out, but I believe it was in part because at that time there was no code for ADR. But anyhow, since then Health America Insurance has been denying coverage for everything they possibly can for me and taking their good old time with every step. So, If I end up needing the additional 2 level ADR, I am sure it is a hopeless battle with this insurance company especially, or any other, most likely.

They rejected my surgeon's pre auth request for the Nucleoplasty procedure that I am having on Thursday. When we appealed it, they said they had 4 weeks to decide, but that it usually only took 2. Well, my doctor had to call them after 6 weeks and they claimed it had been reviewed, just not decided on. I thought we had a good and informative argument too. An hour later they called to say it had been denied. I would love to see these documents you talk about, as I don't think anyone looked at it before that day when it was denied. I don't think mine was supposed to be an Independent Review though. ?? I think it just went in front of their medical review board. I am not sure. I need to learn more about this, that is for sure!!!

Good luck to you Big Red. It sounds like you really know alot about these insurance processes. Are you in the medical or insurance field yourself?? Or self taught for survival?

I have a question - off topic - both Eddie and Chuck mentioned the trial with Dr. Yue and saving $$$. May I ask why? Is some or all of the costs of this trial covered?? Just curious. I have considered seeing Dr. Yue before I take the big step and go to Germany (my next step if this nucleoplasty doesn't work). I imagine I wouldn't be a candidate for Yue's trial or any other trial though.

Well, good luck to all.