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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
05-01-2008, 01:53 AM
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The specialist who is treating me does not take
my insurance and is covered under the out of network coverage of my policy.My question is can I try and get them pay for for 80 percent of the surgery under the terms of the policy or will they say it is experimental 
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#2
05-03-2008, 08:05 AM
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What are you asking? I am unclear of what the question is. Are you asking about ADR surgery or some other surgical procedure?
Terry Newton
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1980 ruptured L4-L5 1988 ruptured SI-L5 1990 ruptured C5-C6 1994 ruptured C6-C7 1995 Hemi-Laminectomy C5-C6, C6-C7 Mayo Clinic Bicycle Accident 2004 MRI, EMG, Facet Injections, Epidural Blocks, Lumbar Discogram. Stenum Hospital Surgery November 4, 2006 Prestige Disc C5-C6, C6-C7 Maverick Disc S1-L5, L4-L5
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#4
05-04-2008, 12:21 PM
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It depends on your insurance policy. Also check to see if you need precertification and whether they will cover ADR. The exclusion as "experimental" would apply whether or not your surgeon is in or out of network.
__________________
2001 MVA; C5-C6 disk extruded ongoing physical therapy, exercise and massage ESI's, oral prednisone, trigger point injections foraminal and central stenosis C5/C6 and c6/C7 2007 EMG/nerve conduction shows pattern of chronic radiculopathy January, 2008: Prestige ST Artificial Disk Replacement, C5/6
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