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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  
Old 02-26-2008, 05:43 AM
Sammy Sammy is offline
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Anyone had any luck/knowledge of Empire BCBS and Cervical ADR?

Any feedback would be greatly appreciated.

Sam

Diagnoised Cervical Spondylotic Myelopathy - Stenosis C5-C6
Past history of Hydrocephalus (Shunted and revised)
One Post-op siezure
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  #2  
Old 02-26-2008, 08:16 AM
Nairek Nairek is offline
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I couldn't get Empire BC/BS to pay for a 1 level disc replacement at L5-S1. I lost all of my appeals with them.

All you can do is try & see if they will pay for it. I hope they will come thru for you.
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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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  #3  
Old 03-01-2008, 06:03 AM
Sammy Sammy is offline
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Karin - Sorry to hear about your difficulties with Empire BC/BS. Thanks to the folks in my surgeon's office (Annie at Dr. Bitan's in NYC), it looks like they will be covering my Level 1 ADR C5/C6 with Prodisc-C.

Not sure how she did it but we did get a call from a BC/BS case worker stating it would be covered - would like to see it in writing though.
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Old 03-01-2008, 10:56 AM
Nairek Nairek is offline
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That's Great! If you don't mind my asking, is the plan thru Horizon BC/BS or a different plan?

I wish my Dr.'s office was a little more proactive when it came to my case. I really felt like I was doing all of the work.

Perhaps your surgeon's office can get that info in writing for you. This is definitely exciting news! Do you have a surgery date set yet? Please keep us updated!
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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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  #5  
Old 03-02-2008, 11:47 AM
Sammy Sammy is offline
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Hey Karin;

The plan is Emprire BC/BS not Horizon. As it is actually a co-insurance it's not a super bargain but still helpful. That may explain some of the willingness to pay a portion.

My surgical date is coming soon, Monday 3/10.

While I did not see the actual documents submitted by Dr. Bitan's office I believe the main focus was that this surgery would prevent future onces down the road from adjacent disc damage.

Sam

Diagnoised Cervical Spondylotic Myelopathy - Stenosis C5-C6
Past history of Hydrocephalus (Shunted and revised)
One Post-op siezure
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  #6  
Old 03-07-2008, 04:36 PM
Sammy Sammy is offline
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Just received hard-copy confirmation of my ADR coverage from Empire BC/BS. If anyone is interested I can provide some details.

Sam

Diagnoised Cervical Spondylotic Myelopathy - Stenosis C5-C6
Past history of Hydrocephalus (Shunted and revised)
One Post-op siezure
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  #7  
Old 03-27-2008, 11:10 AM
mmarsh mmarsh is offline
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Sam

Please send anything you have. I'm appealing BS of CA, but any "precedent" is helpful.

Missy
mdm798@aol.com
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fusion L4-5, Dynesys rods L3-4, fusion c5-6 and C6-7, current problem C-7/T-1
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  #8  
Old 03-30-2008, 09:14 AM
locorebob
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Sam, Could you please send me the material also, I am trying to get United Health care AZ to cover 0090T procedure (cervical ADR) and have been denied.
PLease send to locorebob@hotmail.com
Thanks, Bob
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  #9  
Old 03-31-2008, 02:25 PM
SherryD SherryD is offline
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I am in the early stages of trying to get approved for the cervical disk replacement surgery (C6-C7). I have BCBS as an insurance carrier and my doctors office has told me that BCBS has not approved this procedure. If you could please share a copy of your approval, I would greatly appreciate any help you can give me. I can be reached at sherry.dortch@yahoo.com.
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