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  #11  
Old 10-26-2018, 07:52 PM
GravyBaby's Avatar
GravyBaby GravyBaby is offline
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Join Date: Mar 2018
Posts: 142
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BIG UPDATE:

My insurance company retroactively DENIED my insurance claim for my ADR procedure citing investigational and experimental procedures and technology.

They paid the hospital, I saw it in my Flordia Blue app. 40 grand payment to the hospital reversed. They can't be too happy about that.

Thankfully I've had the procedure. Maybe it's all just a little misunderstanding Let's see what happens.
__________________
2001 - Pulled off monkey bars, landed directly on coccyx.
2006 - Sports injury that made it worse.
2016 - Multiple instances of paralyzing low-back pain.
2017 - Blew out my back on leg-press. MRI showed L5-S-1 disc herniation and grade 1 retrolisthesis.
2018 - Successful ADR surgery with Dr. Rolando Garcia using the Activ-L implant.
2019 - In physical therapy for burning in feet, L4-L5 diffuse disc bulge and SI joint pain.
2020 - Getting better with one-on-one PT.

30 - Male - American
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  #12  
Old 10-26-2018, 08:27 PM
Sewing Violinist Sewing Violinist is offline
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Join Date: Dec 2014
Posts: 5
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Is the hospital that you had the procedure at contracted with your insurance? If so it is my understanding the hospital cannot bill you. The hospital will likely appeal the denial and if it is denied send a second level appeal and if it is denied a second time they will either write if off or litigate it. It is quite the racket And we wonder why healthcare is so expensive in the US.
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C 3-4 mild annular bulge
C 4-5 central disc protrusion
C 5-6 central disc protrusion
C 6-7 posterior disk bulge
Cervical radiculopathy
Right sided sciatica for 15 years, no MRI
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  #13  
Old 10-28-2018, 04:32 PM
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GravyBaby GravyBaby is offline
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Join Date: Mar 2018
Posts: 142
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I would imagine they must be. It's a decent sized hospital and my insurance is Blue Cross Blue Shield of Florida.

More important than the hospital getting paid, I am concerned about my doctors getting their share. I want to make sure they get paid so I can keep following up with them. It looks like they all billed separately from the hospital.

I guess that's why my surgeon wanted 5 grand up front for the surgery even though it was only 3 grand to meet my deductable.

My insurance told me I could expect a refund from my doctor in the difference after they pay him. What a load of malarkey.
__________________
2001 - Pulled off monkey bars, landed directly on coccyx.
2006 - Sports injury that made it worse.
2016 - Multiple instances of paralyzing low-back pain.
2017 - Blew out my back on leg-press. MRI showed L5-S-1 disc herniation and grade 1 retrolisthesis.
2018 - Successful ADR surgery with Dr. Rolando Garcia using the Activ-L implant.
2019 - In physical therapy for burning in feet, L4-L5 diffuse disc bulge and SI joint pain.
2020 - Getting better with one-on-one PT.

30 - Male - American
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