don't assume you'll be denied
Quote:
Originally Posted by Iron
After almost a year and half of researching to figure out what was wrong with me and finding the best way to fix it, I am 99% sure I will be seeing Dr. Clavel very soon for a 3 level Cervical ADR.
I have researched this forum deeply trying to get the best answer just to remain confused as to the correct procedure and order of achieving a Reimbusement from my Insurance Company.
I have Blue Cross
Here is the question:
1. I have read people just going ahead and having the surgery, then sending the surgery info in to Blue Cross for reimbursement.
2. I have read also that people have gone the old preapproval route, sending their information in before.
I have already been through the appeals process for a one level all the way to the external review level, where I backed out because I have a multiple level problem.
Any assistance, guidance or oppinions will be soooo appreciated.
Thank you
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I didn't ask for pre-approval. Later they can say they told you NO. Just file after the service. It's the ole' adage; "better to ask for forgiveness than permission." 1. Have a letter of medical necessity 2. show your conservative treatments for at least 6 months to a year 3. have your insurance codes and amounts in USD 4. show proof of money transfer 5. show proof of surgery/travel and surgery notes all in English. *Send it all registered mail!
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54 yr old female 5'7" 147 lbs. non-smoker conservative treatments failed
2007 fusion @ C4-6 peek cages, failed due to long term use of cox-2 inhibitor
2008 revised C4-6 donor bone, plate & screws
2009 fusion with Roi-C @ C3-4
2015 MRI & CT mjr ddd @ C6-7, segmental kyphosis at C7-T1, 2-level M6-C prosthesis by Dr. Clavel Barcelona Spain
2019 H.O. formed behind M6-C @ C6-7 left nerve rt & in spinal canal.
2020 Revision C6-7 to a CP-ESP prosthesis by Dr. Schmitz Dusseldorf Germany
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