[stanspencer]

I wanted to let the community know about our recent success. My wife had a single level ADR performed on C5/6 in Portland, OR in December, 2010 with a diagnosis of degenerative disc disease and radiculopathy.

All of my internal appeals to Cigna were denied, which is not surprising. I filed an external appeal with IMEDECS, which is one of the independent reviewer organizations (IRO) that was made available to us, and they overturned Cigna's decision not to cover. Cigna is now in the process of reimbursing us for our out-of-pocket expenses.

I have attached my appeal for anyone who is interested. I purchased Laurie's books (The Insurance Warrior), which made all the difference. I also sent our information to her, and she maintains a list of people who have succesfully appealed their insurance companies for ADR surgery.

It was tremendously satisfying to find, and spell out in the appeal, how Cigna broke Oregon state law, and violated the terms of a 2003 federal lawsuit settlement, by not using expert reviewers to deny claims.

In addition, Cigna does cover lumbar ADR, but not cervical. A careful reading of the two policies enabled me to point out the discrepancies between the two. For example, they claim cervical ADR is experimental because the 5 year, post FDA approval results have not been published, but they have covered lumbar ADR within a year of FDA approval, and the 5 year results for it are also not available).

Best of luck to you. I hope you are able to use our information in your fight, and a big thanks to Harrison for maintaining this site, which provides us the information we need to have a fair fight!