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Old 05-11-2009, 02:25 AM
koroni koroni is offline
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Join Date: Mar 2009
Posts: 1
Default 3 level Prodisc C covered by Premera BC in Germany

OK, I don't know if this is a news flash or what, but after 2 months of phone calls and documentation, my Premera Blue Cross plan pre-authorized my multilevel ADR with Dr. Bertagnoli in Germany. I had just refinanced my house to send off the payment in the 3 weeks in advance of my surgery, which took place mid-April, almost 4 weeks ago. (very happy with my results so far, BTW). What a relief to know that my daughter can go to college next year. Dr. B's billing staff honestly didn't know what to do with my pre-authorization letter - they knew it was legit, but I gathered they were surprised that I only had to pay just over $400 in co-pays.

So here's what I know: If you have BC and your card shows a suitcase that has something inside it (like PPO), you have international coverage. I made a lot of anonymous, or 'hypothetically speaking' phone calls before submitting my request for coverage. I took the advice found here and on ProSpine's site, and got plenty of support from Tom Vicknair, who works with Prospine to assist the uninitiated. In the end, it all worked out. I still don't know exactly what did it. I argued that it would be cheaper, I was eligible for overseas coverage and should be held to the standard in the country where it would be performed, and I was willing to incur all the costs of rendering myself to Germany, including any follow-up care and expenses. I also sent my letter of medical necessity, abstracts of Dr B's research, peer-reviewed studies that show that ADR is of the greatest benefit for people like me who need multiple levels replaced. I also added that it would be at least 1/2 the cost of fusion here. Of course, it's possible that none of these factors had anything to do with thier decision, but I think that the major savings to them, and my willingness to go to where FDA approval was meaningless were what did it. I guess I'll never know.

One more thing: Be persistent, but polite, and call back to speak with a different CS rep until you talk to someone who seems sympathetic. Ask for advice in getting it approved. I was coached in what to include to support my claim, and I went to work gathering all the documentation I could. Also, Premera is my secondary insurance, and they told me at the onset that they don't pre-authorize for secondary and I would have to submit the bills after the fact. I told them that I had already been denied by my primary and that I didn't have the funds to do it that way. I had given up. Then I made that last call, just hoping that maybe - somehow - some miracle would occur. The rep I worked with was very supportive and seemed genuinely thrilled to tell me it had been approved and the pre-authorization letter was being prepared. So don't give up!

Hope this helps.
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