Robinson,
Condolences on the condition and on the added and completely unnecessary insurance hassle. Unlike you I am (was) a cervical sufferer, but I locked in an eleven month challenge with my insurance company for reimbursement of a double ADR surgery.
If you are not in so much agony that you can put your surgery off for a couple of months, I do believe that you have a couple of options in getting your insurance company to pay.
Option 1
In
this book the author explains how to appeal to your insurance company and win. She claims a near 100% success rate in helping others with appeals. I used her method to get my carrier to reverse its initial denial of my request for reimbursement. They've since denied on different grounds and I think that I'll be sending that appeal in this week. The book is short, 180 pages, and easy to read. But the ensuing research on your part will take multiple weeks.
Option 2
If you are willing to travel out of country for surgery (doing so is replete with unique risks), it may not be impossible to convince your carrier to cover an out of the country ADR. As a for profit business it should come as no surprise that they care more about profit than anything else. With some research you will be able to find ADR services in India, Thailand, Costa Rica, Mexico and other such countries in which you can receive lumbar ADR for less than it will cost for ALIF here in the US. You will need to:
- Determine the cost of an ALIF at your local hospital (your case manager with your insurance carrier should be willing to provide this information)
- Locate foreign doctors that perform ADR for less than the price your carrier will pay for a local ALIF. I know of two web sites that you can use for this; Planet Hospital and Health Base. I used the latter and have had great success.
- Present the information to your carrier. If the cost difference is significant enough, you should even present your travel expenses as part of the cost. They may cover it.
If they agree to consider your offer, they will contact the provider with whom you've presented them and attempt to get an even better price.
The key for either of these options is that
you have to do all of the leg work and research. If you're willing to work at it, you have a chance of getting your ADR.
Good luck!
Jeff