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| The Big File All issues not easily categorized in the above forums are here. Comments on general health, diet, "getting comfortable," and more are here. |
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#1
10-14-2006, 03:24 AM
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Well, looks like Empire Blue Cross Blue Shield of NY still considers ADR surgery as investigational. They were so "kind" to call me yesterday to let me know. After speaking to someone in appeals to find out what I had to do next, she told me straight up to expect my 1st level appeal to be denied. Nice huh? If I only had enough money left thru no-fault to have this surgery, I wouldn't have to go thru the hassle of dealing with my private healthcare carrier. Looks like I'll be working on my appeal in between homework & studying this weekend. Hopefully I won't confuse Networking security and human biology with peer reviews
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----Karin---- Disc Bulge C4/C5, Disc Degeneration T11/T12, Bi-Lateral tears L5/S1, Diagnosed w/ Lumbar Disc Derangement w/ Radiculopaphy. Treatment: IDET, Percutaneous Discectomy, SI Joint Injection, Facet Block. All failed. Empire BC/BS Denied Coverage for ADR-lost all of my appeals. MVP also denied coverage. ALIF/PLIF Fusion 1/20/09 
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#2
10-14-2006, 06:50 AM
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Sorry, Karin. I was told the same thing by BCBS in Mass., appealed and won coverage. And you could get legal assistance too -- it need not be that expensive. Let me know if you want more details.
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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
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#3
10-15-2006, 09:48 PM
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Hi Harrison,
Thank you for responding to my post. I was hoping to use the legal way as a last resort to going after BC/BS. School has me tapped out in the funds department. However, I would be interested in any details that you can offer to me in case circumstances change. 
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----Karin---- Disc Bulge C4/C5, Disc Degeneration T11/T12, Bi-Lateral tears L5/S1, Diagnosed w/ Lumbar Disc Derangement w/ Radiculopaphy. Treatment: IDET, Percutaneous Discectomy, SI Joint Injection, Facet Block. All failed. Empire BC/BS Denied Coverage for ADR-lost all of my appeals. MVP also denied coverage. ALIF/PLIF Fusion 1/20/09
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#4
10-16-2006, 05:51 AM
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So what is suggested? Is it possible to have BC/BS pay ahead of time vs. hoping they pay post-surgery?
I'd be interested too Harrison in any info. as Dr. Regan thinks waiting is risky re: facets, etc. Karin, I'll hunt down the fellow in a few days for an update re: is there hope w/this insurance company? Good luck. - ans
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Severe, extensive DDD, considered inoperable by Dr. Regan, Lauressen, & some guy at UCLA. Severe foraminal stenosis (guess they can't operate!) and some spinal cord compression that Lauryssen would fix if gets outta hand.
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#5
10-16-2006, 08:46 PM
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Hi Allan,
I would be afraid to have a $75K surgery and not know whether or not BC/BS would pay for it. Even my OS feels that I should wait until BC/BS gets the bug outta their butt. Of course he says this so he will get paid My employer is working with me to try and help speed the process along but she's hitting the same brick wall that I am hitting. If you find out either way from your contact if there is "hope" with BC, please let me know. Perhaps we can help eachother out here with our information.
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----Karin---- Disc Bulge C4/C5, Disc Degeneration T11/T12, Bi-Lateral tears L5/S1, Diagnosed w/ Lumbar Disc Derangement w/ Radiculopaphy. Treatment: IDET, Percutaneous Discectomy, SI Joint Injection, Facet Block. All failed. Empire BC/BS Denied Coverage for ADR-lost all of my appeals. MVP also denied coverage. ALIF/PLIF Fusion 1/20/09
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