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  #11  
Old 12-16-2013, 07:35 PM
bwink23 bwink23 is offline
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Join Date: Nov 2013
Posts: 262
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2Confused....you did say before that you have a WorldWideBlue coverage plan correct? Do you know if this a paid-portion of your coverage, or should most people who have BCBS contact them first before approaching procedure?

Do you know if you PAY for WWBlue or not?

Plus, did you get pre-authorization, or appeal a reinbursement?


Your case could prove invaluable for those seeking coverage thru BCBS. If you have time, i would suggest posting how you went about the process.

I've read that Dr. Clavel is U.S. board certified, this could also play a role in the quest for reminbursement.
__________________
2013 - MRI and CT scan....DDD L4-S1
left side (where my pain is) interarticularis pars fracture/defect with Spondylolithesis L5 over S1 with 2MM anterior displacement

Feb. 2014 - Hybrid lumbar fusion(l5/S1), ADR(L4/L5)...2-level cervical ADR (C5/C6, C6/C7). Dr. Pablo Clavel of Quiron Hospital in Barcelona, Spain. All M6 implants (PEEK cage and plate from Medtronic at fusion level in lumbar.) SAME DAY OPERATION for both areas of the spine.
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  #12  
Old 12-18-2013, 04:30 PM
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jss jss is offline
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Join Date: Nov 2009
Posts: 1,411
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Frank,

I know you did great today. Wishing you a restful night's sleep tonight.

Good luck, Jeff
__________________
C4/5 - ACDF in 2000
C5/6 - ACDF in 2002
C3/4 & C6/7 - M6 ADR, Nov 2009, Barcelona
Conceded defeat to a manifestly disingenuous BCBS-TX in my quest for reimbursement, Jan 2011
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  #13  
Old 12-28-2013, 09:05 AM
FranklySir FranklySir is offline
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Join Date: Jun 2013
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Jeff,

So Sorry for not posting sooner. Yes i am doing fantastic!!!! Surgery went off on 12/18 at 745pm. Climbed on the table myself which was cool.

It was a double edged sword though. I had been working very hard with a private trainer from 1st week of september at the Gym gaining muscle mass back. i had lost alot during the cervical issue and subsequent double M6. i normally walk around at 205 fighting weight. in 14 weeks i put on 18 lbs of muscle and dropped 7% body fat. so im walking around at 225 now.

They really had to beat me up bad to get in there from what Clavel had described and warned me prior in my initial meeting. Great placement on the ADR's. Oh and I'm a freak apparently i have an extra disc S1S2

Waking up up was horrible do to stretching the stomach muscles so drastically. Didnt get out of surgery/recovery 11:30pm. Just the schedule of the day. I was standing the next morning at 8am and walked a short bit, got up and down in a chair. Somewhat painful! Walked around for 20 minutes 3 hours later. Any advice I can give is go in the best you can muster and the reward is tenfold.

today is 10 days out. I have walked about 20 miles total with many breaks. Pain/symptom free but for surgical stuff. Walk walk walk. Have full 90plus degree stretch already on the hammies from the Physio. So im very happy thus far.
Thank you for staying in touch. Ill share more when i get home. Long flight tomorrow. Clavel mentioned a big conference in the UA i believe Spring time with all or a lot of the players. Things have really improved for the better here and not that it was ever bad. Always nice to see people refine there business along with keeping the non rushed, caring, fantastic bedside manner and and just all around great guy. more to follow!
Happy Holidays to all and wishing all the courage, means and emotional strength to get fixed.
All the best,
Frank *** i know wrong location for outcomes*** feel free to move
__________________
Lumbar issues 18 yrs
herniations lumbar L3-5 multiple Epis etc etc
Annular tears L3-5 cauda equina
Cervical herniation symptoms 2011
C5-7 M6C by Dr Clavel on June 5 2013
L3-5 M6L by Dr. Clavel on 12.18.13
Living life instead of living the condition
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  #14  
Old 12-28-2013, 09:11 AM
FranklySir FranklySir is offline
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Bwink,

Dr. Clavel Father was is US board certified. I asked him last week. Doesnt matter. He IMHO is an awesome guy as evidenced by going back for double lumbar 6 months after double cervical.

Insurance is BS since they will find any way in most cases to not pay. Fight facts with facts and they will bend. depends on how much energy you want to spend instead of healing.
__________________
Lumbar issues 18 yrs
herniations lumbar L3-5 multiple Epis etc etc
Annular tears L3-5 cauda equina
Cervical herniation symptoms 2011
C5-7 M6C by Dr Clavel on June 5 2013
L3-5 M6L by Dr. Clavel on 12.18.13
Living life instead of living the condition
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  #15  
Old 12-28-2013, 04:08 PM
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jss jss is offline
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Join Date: Nov 2009
Posts: 1,411
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Frank,

Twenty miles the first week after lumbar ADR?! That's extraordinary! I can think of only three other lumbar patients on this site that have managed something like that. I'm not going to burn the energy it would take to tell you take it easy. Good luck on the loooong flight home.

Jeff
__________________
C4/5 - ACDF in 2000
C5/6 - ACDF in 2002
C3/4 & C6/7 - M6 ADR, Nov 2009, Barcelona
Conceded defeat to a manifestly disingenuous BCBS-TX in my quest for reimbursement, Jan 2011
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  #16  
Old 12-29-2013, 10:25 AM
2Confused 2Confused is offline
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Join Date: Jun 2011
Posts: 322
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Brink,

Yes, I have Worldwide Blue with my BCBS Policy. To be honest I did not know this until I started researching and reading my policy prior to making the decision to go to Spain for surgery. My suggestion would be research your policy to determine if you have WWB. I must assume that it would depend on the type policy one has as to whether WWB is included in their coverage.
I did not seek pre-authorization, nor did I go through the appeal process.
Upon my return from Spain I gathered all the documentation to be sent for my claim and sent it by certified mail to WWB. About 6-8 weeks later we received a letter from BCBS saying my claim was being reviewed. ( we fully expected a denial to arrive soon after) however, A couple of weeks later we received a check in the mail.
I really cannot explain why BCBS paid for my procedure but denies other claims.
I might add I had documentation for over three years of doctor visits, treatments, physical theraphy, a letter of medical necessity from both my NeuroSugeon and Dr. Clavel. All of this was included in the package sent to WWB, with a cover letter CC'd to my attorney.
We also included the following in the cover letter "the procedure performed is not experimental in the country where surgery was performed".
Hope this helps.

Frankly,
Glad to hear you are recovering nicely!! Walking 20 miles? Wow!! Impressive.
Quote:
Originally Posted by bwink23 View Post
2Confused....you did say before that you have a WorldWideBlue coverage plan correct? Do you know if this a paid-portion of your coverage, or should most people who have BCBS contact them first before approaching procedure?

Do you know if you PAY for WWBlue or not?

Plus, did you get pre-authorization, or appeal a reinbursement?


Your case could prove invaluable for those seeking coverage thru BCBS. If you have time, i would suggest posting how you went about the process.

I've read that Dr. Clavel is U.S. board certified, this could also play a role in the quest for reminbursement.
__________________
50 year old female
Rear-Ended in 2009
Disk rupture cervical 5-6 & 6-7
2 level M6 ADR, Dr. Clavel - Oct. 2012
Insurance paid
Not a day goes by that without me whispering a silent "thank you" to Dr. Clavel
Post Op 2+ years
Cross Fit 3-5 times a week
Running 5ks
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