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The Big File All issues not easily categorized in the above forums are here. Comments on general health, diet, "getting comfortable," and more are here.


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  #1  
Old 11-04-2005, 07:40 PM
Kim Kim is offline
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Join Date: Apr 2005
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Hello everyone
I have good news and bad news. The bad news is my ins company denied me for the final time. SIGH. The good news is that our insurance plan is self funded and now I can go directly to the company and ask for out of benefit coverage for my surgery. I am hoping and praying that the company will have better sense and more compassion than our ins did.
What I am asking for is help from you guys. I would like to include with my appeal testimonials from those who have had surgery, whether the ins paid for it or if it was self funded. I think that if others wrote as to how this surgery has helped them return to work etc and why they opted for this as opposed to fusion would greatly help my cause here.
I was told to get my appeal in ASAP as the end of the year is coming soon. I was not told why it needed to be in now but I am not questioning it.
So if anyone out there would be so kind as to write a letter for me of their journey and include the above information in it I would be forever grateful. I would like to get these this weekend if at all possible because I want to get the appeal in the mail on Monday. Too much time has passed with this and I am tired of the hassle of it all!
If you have any questions, please feel free to PM me!
Thanks in advance
Kim
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Kim
Herniated disc L5/S1 2000 Discectomy 10/2003 Rhizotomy 8/2004 and 3/2005Discogram 11/04 grade 7 tear L5/S1
L4/L5 Grade 5 tear with herniation and stenosis
Evaluated by Dr Blumenthal at TBI
2/2005 ADR 2 level recommended
2 level lumbar fusion
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  #2  
Old 11-04-2005, 11:36 PM
kristi kristi is offline
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I am Kristi's mom and I'm sorry I can't really help you. But I understand your situation. Kristi is getting ready to try to get some help from her employer. a school district, and we had not thought about getting testamonials of success stories. (We are not optimistic about getting help the school district at all.) I think the testamonials are a great idea, especially if someone who has had a two-level ADR would tell their story. I think Poncho, member #32, had a successful two-level Prodisc ADR. Hopefully, you get some responses quickly.

Good Luck.
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UHC insurance
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  #3  
Old 11-05-2005, 01:44 AM
Poncho Poncho is offline
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Hi Kristi,

I just read this post and need to formulate some thought into writing this letter. Is there some sort of template or any specific key points you want us to highlight in this letter?
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Sincerely,
Poncho (aka Prodisc Poster Girl)
2 level ADR (Prodisc)
Dr. Bertagnoli May 22, 2004 Rudolfinerhaus Vienna, Austria.
Currently DRUG FREE and living life again!
Knowledge is Power!!!
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  #4  
Old 11-05-2005, 04:26 AM
Alastair Alastair is offline
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Just look at my story or any of the peoples Patient stories -- - - --maybe you need more explicit stuff
Best
Alastair

Loads of people have done this
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ADR Munich 26th July 2002 L5/S1. Aged 82 now
Your best asset is your health
My story is here
http://www.adrsupport.org/alastair.html
Thank goodness for Dr Zeegers I am painfree
I am here to help,I live in the UK


I now run the UK spine site and can be contacted at

www.adrsupportuk.com/
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  #5  
Old 11-05-2005, 09:13 AM
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Harrison Harrison is offline
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Kim,

I did appeal and "won" coverage from BCBS of Mass. Part of this is covered in my story here.
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Fell on my ***winter 2003, Canceled fusion April 6 2004
Reborn June 25th, 2004, L5-S1 ADR Charite in Boston
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  #6  
Old 11-05-2005, 03:14 PM
Kim Kim is offline
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Join Date: Apr 2005
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Hello Everyone
The template or guidelines are a great idea and Kristi sent me some stuff that made good sense after I saw it hehe.

Please address the letter
To Whom it May Concern:

1. Your age, condition, lifestyle, and profession prior to back problems.
2. Limitations that your condition placed on you, unable to work etc.
3. Recommendations of medical docs and research you did to come to this decision.
4. Why you chose ADR over fusion. Cost concerns, less recovery period, back to work sooner etc
5. Levels of surgery and when it was done, who performed it, ins paid? how long ago etc.
6. Your condition now and improvements, gone back to work, better life quality etc.
If you could sign it with your full name and say city and state so they know this is a real person lol and I am not sending them letters I made up would be great.
Thanks guys I really appreciate all the help.
Laura has already sent me her letter and it was awesome!
I saw you cannot argue with real results, people and ins companies can spout what they will but the proof is in the pudding.
Thanks for any help you can provide!
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Kim
Herniated disc L5/S1 2000 Discectomy 10/2003 Rhizotomy 8/2004 and 3/2005Discogram 11/04 grade 7 tear L5/S1
L4/L5 Grade 5 tear with herniation and stenosis
Evaluated by Dr Blumenthal at TBI
2/2005 ADR 2 level recommended
2 level lumbar fusion
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  #7  
Old 11-06-2005, 12:48 AM
gary gary is offline
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Join Date: Dec 2004
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i am also willing....
i am a trials patient of 3+ years ago here in California, and totally satisfied!
gary
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DrRickDelamarter 07/2002/47yrsyoung
complete collapse L4 L5&Partial L5,S1 from surgery in
'79...
1979Laminectomy@L4,5/mylegram tech
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