Hi Stan,
I don't want to be the bearer of bad news and many people here are having sucess with getting insurance to pay for their ADR, but I don't have a good story to tell. I recently posted about code problems and have been going through a nightmare the last few days here.
My husband, who needs the ADR, is a Federal Employee(post office) but has workmans' comp for his back injury right now, so maybe this is different than your case. His regular insurance is Federal BCBS which is BCBS of Illinois(which the doctors office just told me. We are seeing Dr. Geisler in Chicago, supposedly one of the more experienced surgeons in the US, involved in the trials. We saw him in October, he said Pat was a perfect candidate also, but pending some tests to see is vascular access was possible, seeing how he needs a much higher disc(L2/L3). That was done by end of November and surgery requests sent off to workers comp. We were told it would take 2-3 months. We checked weekly but would always get the run around. Then in mid-March an approval letter came in the mail. It was such a happy day.....however, short lived. Upon contacting the doctor's office, were told the wrong surgery code was approved. How could that happen, we say? Weren't the codes submitted by the doctor's office? Yes, they say, but shortly after they submitted them, the AMA assigned new codes to ADR,as a result of it becomming FDA approved. We call workers comp, they have no such code, we call blue cross, they have no such code. We were told there was no possibility of an authorization for a surgery code they don't have in their data base. After numerous phone calls the last couple of weeks, we have had many ups and downs, but we are still no further ahead. I called places like TBI and even called Dr. McAfee's office, and they told me they are billing under old codes and are under no obligation to bill the new ones until July 1, which is the story I get from the AMA website and also a personal email from the AMA. See, our doctor's office claims that the hospital will no longer schedule a surgery unless they have authorizaiotn with the new codes, as they've been stiffed before. How did we get so lucky to get, apparently, the only hospital/doctor in the US that won't bill the old codes. I pointed out what the AMA says and they claim that they talked to someone higher up and the story is that it's fraud to bill old codes, and they will be checking into the places that are doing so. I don't know who to believe. I'd go somewhere else but we are in Michigan we need a very experienced surgeon, and they all seem to be in the bigger, coastal cities: California, Texas, Maryland, Florida. My husband is ready to throw in the towel and go back to his regular ns who refused to do a fusion and beg him.....we feel hopeless. We seem to be the only ones having this code problem, and unless we have the money upfront, the doctors office is NOT going to schedule it. Sorry, Dr. Geisler, I don't care how good you are, if I had to pay for it, we'd be on our way to Germany for superior care and less expense. My feeling is you need to move fast, try to get this done before the AMA, the hospitals or who-the-hell ever catches on and possibly follows suit like Rush Copley Hospital in Aurora Illinois and Dr. Fred Geisler and decide they will not accept an authorization with the wrong "code".
Sorry, this has turned into a vent more than advise and help to you. I just want you to be prepared for a fight. We've been fighting like hell and have gotten no where.
Best of luck to you,
Robin
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