[Brad]

As I have stated in another post CIGNA PPO denied my 2 level. Today I went back to the original doctor that told me to look into ADR 1.5 years ago. I told him I was back to square one. He recently got trained by J&J for the Charite.

He told me some interesting things:
1. The ADR procedure really does not take that much more (in regards to resources) than a typical fusion. He said you still need a vascular doctor and the time it takes to do an ADR is not that much different. The problem is that each disc costs $11,000 here. The same disc in Europe costs $3000.00. So the insurance companies don't want to pay.

2. He was equally outraged about the denial and said that I should appeal it. He told me something interesting. His office insurance premium for his employees went up 20% (the insurance he offers to his nurses, etc). At the same time THE SAME insurance company cut his payment for services to his patience by 5% across the board. In other words they are both cutting compensation to doctors and increasing premiums for insurance.

It looks like there are two parties responsible for this problem. Not just the insurance companies but also J&J for charging $11K for the same disc that they charge $3K for in Europe.

It would be interesting to know if the denial rate would go down if the disc was the same price as it is in Europe.

Anyway, I thought I would share this as the insurance denial topic is a big one at this time.

Brad