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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 03-10-2006, 12:18 PM
go*big*red go*big*red is offline
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Hi, all.

Okay, the next and final step is an Independent Medical Review. There has not been a case where UHC or Pacificare for that matter has approved an artificial disc replacement to date. But, why not me????? Why can't I be the first????? Someone has to be, right?

How long does it take for an Independent Review? I realize that it varies, but can anyone give me an idea? I'm dieing here.
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Juvenile Discogenic Disease
2 level ACDF C5/6, C6/7
Redo on C6/7
PLIF L5/S1 - hdwr removed when C6/7 revision
PLIF L4/5 & Dynesys L3/4 10/10/06. Looking forward to living again.
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  #2  
Old 03-10-2006, 01:25 PM
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blue crap told like 2 weeks
chuck
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  #3  
Old 03-10-2006, 04:23 PM
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Harrison Harrison is offline
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I believe Chuck is referring to Blue Cross Blue Shield, also known as Blue Corpse Blue Sled.

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Fell on my ***winter 2003, Canceled fusion April 6 2004
Reborn June 25th, 2004, L5-S1 ADR Charite in Boston
Founder & moderator of ADRSupport - 2004
Founder Arthroplasty Patient Foundation a 501(c)(3) - 2006
Creator & producer, Why Am I Still Sick? - 2012
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Old 03-10-2006, 04:49 PM
go*big*red go*big*red is offline
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Yeah, that's what I figured, Harrison.

So, Chuck, in reading your signature line, you are still waiting for SOMETHING???
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Juvenile Discogenic Disease
2 level ACDF C5/6, C6/7
Redo on C6/7
PLIF L5/S1 - hdwr removed when C6/7 revision
PLIF L4/5 & Dynesys L3/4 10/10/06. Looking forward to living again.
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  #5  
Old 03-10-2006, 10:44 PM
Kim Kim is offline
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I read somewhere by law they have 30 days to do the review in but dont hold your breath it will be in your hands in 30 days mine would do the review and date it the day before the 30 days was up or on the 30 day mark then took about 10 days to get it out to me.
I had Great West then but have UHC now. Hope this helps
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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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  #6  
Old 03-11-2006, 07:34 AM
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go*big*red
i leaving tomorrow sunday to guilford ct to see dr james yue. to see if i can get into the fda clinial trials comparing prodisc to activ-l adr. if im not a candidate ill be asking for a referal to pro-spine
i have my lastest films on cd both ct scan and mri no concast.cd is cool all the nurses told me they don't do that but later talked to someone else and said it was no problem and it was free. also includes all the reports. just put cd in a pc and has the 3d viewer all on the disc.i have been waiting and fighting with insurance company for well over 2 yrs enough im getting fixed this yr 2006. so hopefully im still good to go i was offered the prodisc study by dr balderston at pa hosp a yr ago so i hope i still am. i really rather not have to borrow the money in case i end up in that 10% that doesnt do well.
best wishes
chuck
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  #7  
Old 03-11-2006, 07:42 AM
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go*big*red
also watch the appeal process but your reply time for appeals gets shorter after each appeal the second appeal with blue crap i only 2 weeks to get the last one started. they really r pricks {insurance companys} and what really kills me is the ceo of blue crap here made 27 million last yr. and this yr there asking for a 30% increase in premiums. and they dont want to pay for any thing. i had letters written by professions. and in my mind all apeals were denied before they hit anyones desk. i also sent about 50 pounds of info comparring adr to fusion to not advil.hopefully this isnt the case for you
wishing you the best of luck with our appeals one thing in your favor is more time has passed.
chuck
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  #8  
Old 03-13-2006, 04:41 PM
Paul Paul is offline
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Good luck with that. I had no luck with UHC. The whole process is a scam. The get to pick the doctors etc. It is a total crock. They pay these retired fossils to do the reviews so you know where they are going to side on. My first appeal doc was a retired arthritis doctor. I have heard also that they use a diabetes specialist. From the time I have spent on this forum I have noticed UHC being the worse. That being said someone has to be the first so I hope you are it. Good luck.
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  #9  
Old 03-13-2006, 10:39 PM
APS APS is offline
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Hi all,
I haven't posted in awhile. I am working on my first appeal letter to UHC right now. My denial letter was signed by a medical director whose specialty was geriatric/elder care. That's helpful...not.
And yes, someone has to be first, so no giving up!
Andrea
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Failed L4-5 diskectomies '93 & '00
ADR originally scheduled 3/9/05; dropped insurance appeal due to new job; new insurance UHC
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  #10  
Old 03-13-2006, 10:48 PM
Kim Kim is offline
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I agree with the 2 above my first appeal was reviewed by an OB/GYN, the second time supposedly by an orthoapedic surgeon. His suggestions were so ludicrous that I questioned it. I got through to find out who he was and ROFL he was a local doc here so I called his office and asked them about him. I found out he was a sports med dr and worked on elbows, shoulders and knees, had not done any spine surgery for 12 years since he was in the military. U can bet I brought this up in my final appeal. Same thing happened again sigh. Its so great they call it an independant medical review but they get to choose the company and of course the ins pays for the consultation so which side do you think the doc is going to decide on and how long would he be employed in such endeavors if he disagrees with the ins company and they have to approve procedures that they dont want to?
Oh and get this, the ins company rep told me that they dont even specify who the doc is when they send a case to the medical review company they leave it up to that company to find someone who is qualified.
Oh the wonderful things u can find out when you delve into the workings of the lovely insurance folks.
I wish you much luck and much more luck than I had during the process.
I had Great West and now I have UHC and from what I have seen so far yeah you can do worse Great West is by far the worst ins I have ever dealt with in all my years. That includes 25 years background in the medical field and even did some insurance billing for a few years a while back.
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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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