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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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Old 07-05-2010, 12:29 PM
mattbrand mattbrand is offline
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Join Date: Jun 2010
Posts: 18
Default Anyone Have TRICARE or The Veterans Administration Pay for Their ADR?

Hello All;

Both my insurance providers, TRICARE and the Veterans Administration (VA)--the VA here in the US and their Foreign Medical Program (FMP) in Europe--have said they will not pay for ADR. I have been told that for an appeal to be successful it helps to have a list of people who have had the same insurance provider pay for their ADR as a part of the appeal package. So, has anybody out there had their ADR paid for by TRICARE or the VA? If so, could you please let me know and provide your full name, surgery date, diagnosis and the details of the payment from TRICARE or the VA. Here is an example used by Laurie Todd (The Insurance Warrior) in her book:

1. Martin Miller (surgery date 4/2/09).
Diagnosis: carcinoid tumors of appendiceal origin
Acme (CA) signs single-case contract with Dr. Sugarbaker and pays WHC.

Any help anyone can give me with this issue is greatly appreciated. Please respond anyway you want--via this forum or my e-mail address is: matthew.brandstett@att.net My phone number is 847-986-4064.

While I'm fishing for information I have another issue I am soliciting feedback on. It has to do with facet joint pain and is explained below. If you have any information or feedback you are willing to share on this issue also, please contact me via the above specified contact info.

Facet joint pain:

Can anyone give me any information about facet joint pain being caused if an ADR is done and there is VERY little disc space left between the vertebrae? I have seen EIGHT (8) neurosurgeons. All in the Chicago area except two who I sent my MRI to. ALL of them said I have such little disc space left I am sure to have extreme facet joint pain that I will never be able to remedy if I do have ADR surgery. Supposedly the facet joints have settled and are used to not moving around and if they are suddenly stretched out in ADR surgery to a great extent (which happens if you have very little disc space left) then his extreme stretching combined with all the motion they have to do now after being immobile and compressed for years will cause extreme pain.

Some of these surgeons said there is a class action suit out now with patients who have been afflicted this way. Supposedly the manufacturer of one or some of the discs are being sued since they should have known this and stated this as an ADR exclusion factor to the surgeons who did not know that this would be a problem.

The only surgeon here in the US who would even consider ADR for me is Dr. Delamarter in Santa Monica/Los Angeles California. However, before he determines if he will do ADR on me he wants me to fly out there for an appointment. Since I am in Chicago I am holding off on that. Dr. Bertagnoli in Germany has said he will do ADR on me so I am currently leaning towards him. However, I am still concerned the other surgeons may be correct and the facet joint pain will be an issue even thought these two think it would not be.
Thanks again to any respondees.

Matthew
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