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Insurance Hell All insurance-related matters are here: Medicare, worker's compensation, appeals, denials, insights, wins, losses. PRICING is here too. Note: This forum has posts from 2006 forward. Older ones are in the Big File. |
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#1
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Aetna - cervical one level
Last year Aetna denied my 2 lumbar disc replacements as "not covered by policy" and the lawyer said since they didn't deny it as "not medically necessary" that I wouldn't win in court.
So, I was pleasantly surprised when I called them to get an update on my one level disc replacement in my neck and they said it didn't require pre-authorization, only pre-notification (coverage determination). Shocking as I needed pre-authorization for a $200 prescription but not for an expensive surgery. Getting one level done is better than none, and it is the one that is symptomatic at this time. I'm scheduling the surgery now and once it's done, going to try to submit for lumbar again. I'm getting nervous!!! C
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Chris Back and Neck Pain 30+ years, Chiropractic care Several Epidurals and Blocks over past 5 years Awaiting Insurance for 2 ADR Lumbar L5-S1 L4-L5 Discogram showed Shredded L5-S1 5 YO MRI of neck shows straightening of cervical spine, issues at C4-5 & C5-6 and C6-7 (central disk protrusions, bilateral uncovertebral joint arthropathy, moderate neural forminal stenosis, severe central stenosis with cord compression) Aetna approved C6-7 replacement, scheduled for 11/17 |
#2
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Congrats, Chris! Keep us posted.
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"Harrison" - info (at) adrsupport.org Fell on my ***winter 2003, Canceled fusion April 6 2004 Reborn June 25th, 2004, L5-S1 ADR Charite in Boston Founder & moderator of ADRSupport - 2004 Founder Arthroplasty Patient Foundation a 501(c)(3) - 2006 Creator & producer, Why Am I Still Sick? - 2012 Donate www.arthropatient.org/about/donate |
#3
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Yes, congratulations and keep us updated. Maybe if you get the one level now you can get the second level done next year? I know Tricare started approving one-level cervical ADR's on May 1, 2014.
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1998- Injured neck and back in USAF 2011 - Started experiencing Severe Symptoms, Migranes, numbness, spasms in legs and feet and sciatica. Feb 2014 - Received upper Lumbar Injection - Severe Allergy to injection Mar 2014 - MRI of Cervical and Lumbar, protruding disc in C3-7, Herniated Disc in L5/S1, placed on STD and FMLA ) July 2014 - Stem Cell Procedure performed Oct 20, 2014 - ADR (MOBI-C) at C5-7 and Anterior Fusion at L5/S1 by Dr. Pettine and Dr. Techy |
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