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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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Old 11-16-2017, 10:53 AM
GKTM300 GKTM300 is offline
Senior Member
Join Date: Dec 2015
Posts: 273
Default Website

Looks like Bert is updating his websites. He lists two people to contact about insurance claims. His site is posting newer relavant information and he talks about the m6 short comings. I'm betting you will never get a USA Ins company to pay for a non FDA approved device though. I'm pretty sure the m6 will be taken off the market soon. The arguments Bert brings up sound pertanant to me sp
12/22/04 blew L4-5 and L5-S1 out lifting wrong
4/1/05 back to work thanks to Oxy
11/11/13 hurt back lifting again
6/6/15 last of many MRI L4-5 medium paracentral bulge with juice leaking and mid to left bulge on L5-S1
No invasive procedures except steroid shots that did nothing n hurt wicked bad
9/24/2016 Adr surgery Bertagnoli>1 year doing great
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Old 11-22-2017, 10:28 PM
ia75 ia75 is offline
Junior Member
Join Date: Oct 2017
Posts: 16
Default Out of pocket

Originally Posted by ouchtear View Post
After months and months of internal appeals and finally a external appeal from New York state it was finally denied. I was going to have a one level l5-s1 done with either a Prodisc L or Activ L at the Texas Back institute. It's such bull****.. No evidence to support it is better than fusion... Then with that logic there is NO evidence to support that it is worse. So then let me chose then... I guess I am at square 1 again.. I may just take a gamble and pay for it out of pocket somewhere...submit it and then fight them like hell to pay for it..
TBI charges $36,000 for a one-level ADR...
42 y.o. female, athletic build, otherwise healthy
L5-SI: Severe DDD with subtotal disc collapse, mild to moderate bil. foraminal stenosis.
2007: car accident, mild herniation, intermittent pain.
2012-17: pain chronic, progressive, resistant to conventional treatment.
06/2017: Discogram, MRI
10/04/2017: ADR surgery denied by BCBS (FEP),

Pain is severe and disabling
04/04/2018: ADR surgery using LP-ESP disc with Dr. Desai
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Old 04-29-2019, 01:55 PM
ouchtear ouchtear is offline
Junior Member
Join Date: Feb 2015
Posts: 14
Default (Update) WON new appeal BCBS NY

The second time was a charm. I went through the process again and won. Had my surgery 11 days ago. My winning appeal letter is on the Facebook adr forum files section. I also used the Laurie Todd Book " How to fight your insurance company and win" as a guide. I am recovering now and hope to get better each day.
ActivL l5/S1 2019 at TBI
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