Hello all,
As we all know, insurance companies can sometimes cause enough frustration to make us forget about our physical pain. There's someone out there who's made a habit of defeating these behemoths and making them bend into submission (aka
The Insurance Warrior). I recently went to speak with her and she told me one of the main things we need in any successful appeal for denial of service/payment is as many precedent cases as we can find. To get to the point, I'm setting this thread up so that there's a common place for people to come and make their information available for the community members' use in these endeavors. In other threads, people have mentioned PM'ing people that have had luck with insurance companies and I've PM'd a couple people but I'm also hoping that this new appropriately titled thread will attract some attention and can be a 1-stop info shop for people like me that are searching for this information from the community. Hopefully I can be the last person that has to work to get this information!
Who we need:
- Any ADR patients (single or multiple levels) that have had their insurance company actually cover the procedure
- Any fusion patients that have had post-op complications or fusion-related issues (i.e. adjacent discs deteriorating, etc.)
- Any ADR or fusion patients that don't fit into either of these categories (we can always use more data for cost-comparison purposes)
What we need (whatever you feel comfortable sharing):
- Name
- Insurance company
- Date(s)/location(s) of surgery
- Costs - to be used for cost-comparison to show that ADR is more cost-effective than fusion (if possible, broken down into sub-categories: hospital, drugs, physician, materials, repeat/revision surgeries, travel, etc.)
- Appeal letter if you appealed and were successful!
If you're not comfortable posting this information publicly, please just make a generic post that says "PM me for details" or something like that - so that at least we have all the people that can help with this in one place.
I'm planning on writing an appeal to BC/BS of california using the strategies outlined in Laurie Todd's book. In return for any info posted here (and this wouldn't just be helping me since everyone can see this thread), I will post my successful appeal for people to plagiarise at their heart's content (assuming I am successful
- Laurie has a high confidence level in this as she's already helped someone get ADR paid for). Note that any private info I receive will not be included in the post of the successful appeal without that person's consent.
Thanks for your time and I hope this thread does what I hope it will!
-Anthony