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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
05-10-2014, 12:37 PM
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Anyone willing to proofread my appeal?
I don't know if anyone has asked this before. But writing an appeal can be such a huge, frustrating and lonely task!
 I've got one last big shot in my appeals process. I thought of asking my friends to proof read, but it would be a topic that is completely foreign to them. Who better to ask than my ADR Besties? I'm still working on it, but I would sooo appreciate input from whomever is willing to look it over before I send it. I should have it done by the end of the week. 
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2004 MRI -cervical bone spur causing pain 2011 MRI -5 bulging discs at C3-7: Recommended C5-6 and C6-7 for a two level fusion, I said no thanks. 2014 MRI -progressive compression C5-7. MRI 6/5/14- Ruptured L4-5, bulge at L2-3 and L5-S1 Dr recommends discectomy of L4-5 but won't do surgery until cervical is stable 8/2014- 8 months/3 rounds of appeals, Aetna denies 2 level cervical ADR  2 level ADR w/ mobi-c C5-7 Jan 7, 2015 
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#2
05-10-2014, 02:07 PM
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Sure
Kelly,
I'd be happy to give it a read. : ) Michele
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Sept. 2008 Car accident (rear ended) Nov. 2010 Prodisc at C5-6 Oct. 2012 Car accident (t-boned on driver's side) Nov. 2013 2 more Prodiscs at C3-4 & C4-5
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#3
05-10-2014, 03:20 PM
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Kelly, i would also if need be.
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Born 1970/1995-Hurt at work/1996-Right disc fragment L4-L5 discectomy-On/off back pain,no serious leg pain until/2007-Right herniation L5-S1,recurrent small herniation at L4-L5 with unbearable leg pain/6/08 discectomy L5-S1/leg pain relieved/occaisional mechanical pain/2012-Cymblata 60 mg,occasional aleve/2014-LB pain not debilitating but chronic,Rhizotomy relieves facet pain on right side/2015-L4-S1 facets shot/4/15 PLIF L4-S1 with facectomy
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#4
05-10-2014, 09:57 PM
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Kelly,
I would be glad to review it. Gene
__________________
Car Accident 2002 - Small Herniated Disc C3/C4 1998 Larger Herniation and Cervical Fusion C3/C4 2005 Herniation C4/C5 - 40 epidural steroid injections from Oct 2005, - Oct, 2007 2008 - Foraminotomy at C6/C7 on left side Feb, 2010 - Cervical Fusion C4/C5 Dec, 2010 - Lumbar Fusion L3/L5 2013 - Bulge on C5/C6; herniation C6/C7 right side Mar 26, 2013 - Foraminotomy at C6/C7 on right side May 5, 2015 - ADR with Dr Blumenthal of TBI for C5/C6 using Mobi-C
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#5
05-10-2014, 11:29 PM
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Thanks everyone, I already feel better having some eyes other than mine on it. I was going to work on it some more tonight but ironically, all the computer work aggregates my neck and arm pain something awful
 I'll PM everyone and send it via email when I get it done later this week. This really means a lot to me, thank you.
__________________
2004 MRI -cervical bone spur causing pain 2011 MRI -5 bulging discs at C3-7: Recommended C5-6 and C6-7 for a two level fusion, I said no thanks. 2014 MRI -progressive compression C5-7. MRI 6/5/14- Ruptured L4-5, bulge at L2-3 and L5-S1 Dr recommends discectomy of L4-5 but won't do surgery until cervical is stable 8/2014- 8 months/3 rounds of appeals, Aetna denies 2 level cervical ADR 2 level ADR w/ mobi-c C5-7 Jan 7, 2015
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#7
05-12-2014, 06:48 PM
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Appeal
I just sent my appeal, today, had it bound, sent to two places, I read this at least twice and still found a typo.
Oh well, it is about 40 pages, all together. It is a good idea to have someone go over it, and make suggestions, I used another person's outline, so I had a good place to start. Let me know if you want some help (ALSO).
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Jerry, Somewhere Ohio L2-3 herniation, two days before Thanksgiving, 2012, Discectomy/Laminectomy, 3/13 Numbness in the right leg, lateral femoral, gone, July 10, 2014 L45 M6 ADR, July 15 PLIF L5-S1, Not able to access L51 Anterior.
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#8
05-12-2014, 07:26 PM
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Maybe rethink the Mobidisc
deleted the contents, this was meant for another topic, sorry.
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Jerry, Somewhere Ohio L2-3 herniation, two days before Thanksgiving, 2012, Discectomy/Laminectomy, 3/13 Numbness in the right leg, lateral femoral, gone, July 10, 2014 L45 M6 ADR, July 15 PLIF L5-S1, Not able to access L51 Anterior. Last edited by Jerry5; 05-12-2014 at 07:29 PM. Reason: wrong thread
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#9
05-13-2014, 12:05 AM
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A big TIA
Thanks everyone, i am so greatful to anyone who is willing to look it over. Unfortunately I had to slow down a bit, typing on the computer is the absolute worst thing for my neck and now my low back is reacting, ugh. I have low back issues as well, hoping to deal with that in a completely different decade as the neck is priority. As a massage therapist I would really appreciate full use of my arm!! I even missed work today because of it
 I'll send it out to everyone who is willing if I ever get it done. Good luck Jerry, I'll be praying for a positive outcome for you.
__________________
2004 MRI -cervical bone spur causing pain 2011 MRI -5 bulging discs at C3-7: Recommended C5-6 and C6-7 for a two level fusion, I said no thanks. 2014 MRI -progressive compression C5-7. MRI 6/5/14- Ruptured L4-5, bulge at L2-3 and L5-S1 Dr recommends discectomy of L4-5 but won't do surgery until cervical is stable 8/2014- 8 months/3 rounds of appeals, Aetna denies 2 level cervical ADR 2 level ADR w/ mobi-c C5-7 Jan 7, 2015
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#10
06-11-2014, 06:22 PM
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Changes
Wow... I just looked at the date of my last post in this thread, that day was a turning point for me. What had been a cranky low back for 5 weeks, turned disc rupture at L4-5. You can read my MRI report in "spinal round table" thread "joining the low back problem club".
In light of all this, I had to change my plan a bit. With the help of my surgeons office and a company called MCRA, I was going to submit an appeal on my behalf and include their documents. Since I haven't been able to work on it (and time is an issue since my low back depends on my cervical) I turned it back over to Gail at MCRA who will submit it on my behalf. So instead of completing my 40 page document, I condensed it to a 4 page attestation letter that she will put with her 81 page document as well as my chart notes and letters from my Dr. Long story short...I sent my letter to her yesterday so I don't need proofreaders. I am happy to still send it if anyone wants to read it. Now praying constantly that it will be approved so I can get this party started. Thanks everyone for your willingness, it means a lot to me.
__________________
2004 MRI -cervical bone spur causing pain 2011 MRI -5 bulging discs at C3-7: Recommended C5-6 and C6-7 for a two level fusion, I said no thanks. 2014 MRI -progressive compression C5-7. MRI 6/5/14- Ruptured L4-5, bulge at L2-3 and L5-S1 Dr recommends discectomy of L4-5 but won't do surgery until cervical is stable 8/2014- 8 months/3 rounds of appeals, Aetna denies 2 level cervical ADR 2 level ADR w/ mobi-c C5-7 Jan 7, 2015
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