Hello everyone. I am new to this site as of a few days ago. I am currently handling all of the details related to my wife, Katie. She has had lower back pain for over 3 years. We had seen 4 different doctors for a diagnosis and had received different answers ranging from "I don't know" to "a growth in the lower back, snaking into her spinal column". After going through physical therapy, pain management, swimming, wearing a custom-made brace, pain-killing injections, and different oral narcotics, (none of which helped), we saw an orthopaedic doctor. He consulted us in March, and after examining her and her MRI's, he diagnosed her with significant DDD at L5-S1, and told us she was a perfect candidate for the ADR procedure.
The doctors office submitted a pre-Certification form for the ADR procedure, which was lost in the shuffle for a month and a half. Someone in the insurance company sent it to the wrong department with the wrong doctors name attached. After we straightened out the mess, the pre-cert was denied, which I know will come as no shock to any of you.
Since then, we requested that the doctor call the insurance company to perform a peer-to-peer appeal, which he did. This too has been denied.
I am now in the process of composing a written appeal. After reading the posts of other members and knowing what they have gone through, I wish to laden this down with as much research and back-up evidence as possible.
Can anyone point me in the right direction of where to search for articles and studies done on the ADR procedure?
Your help is much appreciated. Thank you.
Drew
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