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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  
Old 12-23-2013, 08:22 PM
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jasonhhh jasonhhh is offline
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Default Adr covered by bcbs

Well I just got my check in the mail from bcbs ny I had a 2 level lumbar disc replacement with the l-m6 done by doctor clavel just went had the surgery done and came home and submitted claim no problems. I think the trick is not getting preauthorization before surgery.im so happy worked too hard not to get the money back
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Old 12-23-2013, 09:45 PM
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Harrison Harrison is offline
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Jason, do you have the Global Blue flavor of BCBS?
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  #3  
Old 12-23-2013, 10:05 PM
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jasonhhh jasonhhh is offline
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Quote:
Originally Posted by Harrison View Post
Jason, do you have the Global Blue flavor of BCBS?
im not sure but I know when I went to file the claim they sent me over seas forums not the regular ones which were sent to a different dept to be broken down before being sent to the regular dept is what I was told by the lady I spoke with over the phone
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Old 12-23-2013, 10:10 PM
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jasonhhh jasonhhh is offline
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I know dr clavel and quiron hospital except bcbc 100 percent and after I had surgery Yolanda said it will take a few months but most patients are getting reimbursed and this procedure is the norm there so no American experimental crap
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Old 12-25-2013, 03:41 PM
bwink23 bwink23 is offline
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Jason....You are truly a rarity, most people are not getting covered for this. If fact, about 99% of people who i've read that went overseas for surgery are not.

If you would, could you verify for the forum if you have international coverage for BCBS or not, that makes all the difference in the world....Some have full coverage for overseas work performed, some just have emergency coverage.

Did you get the forms from Dr. Clavel, did he submit the initial hospital codes for you or did you have to get that information and do it all on your own?
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left side (where my pain is) interarticularis pars fracture/defect with Spondylolithesis L5 over S1 with 2MM anterior displacement

Feb. 2014 - Hybrid lumbar fusion(l5/S1), ADR(L4/L5)...2-level cervical ADR (C5/C6, C6/C7). Dr. Pablo Clavel of Quiron Hospital in Barcelona, Spain. All M6 implants (PEEK cage and plate from Medtronic at fusion level in lumbar.) SAME DAY OPERATION for both areas of the spine.
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  #6  
Old 12-25-2013, 07:44 PM
Jerry5 Jerry5 is offline
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jason,
like the others here, can you give some details.

First do you have the international waiver?

You paid all of this upfront?

Did you submit the forms?

What percentage did BCBS cover?

I have BCBS, and should have switched to Aetna, after reading all the fine print, they consider ADR 'investigational'.

This is of course BS.

Everyone should write their Congressman, and ask why the Spinal Kinetics, M6, is not approved for use in the USA, why?

J&J bought DePuy, and it is a cash cow, both the Charite and the ProDisc, are owned by J&J.

Let us know jason, glad to read you have yours.

Jerry
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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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  #7  
Old 12-25-2013, 09:25 PM
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jasonhhh jasonhhh is offline
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Quote:
Originally Posted by bwink23 View Post
Jason....You are truly a rarity, most people are not getting covered for this. If fact, about 99% of people who i've read that went overseas for surgery are not.

If you would, could you verify for the forum if you have international coverage for BCBS or not, that makes all the difference in the world....Some have full coverage for overseas work performed, some just have emergency coverage.

Did you get the forms from Dr. Clavel, did he submit the initial hospital codes for you or did you have to get that information and do it all on your own?
dr clavels office gave me the full bill written out with cost,codes I submitted myself to the insurance company with a copy of my wire transfer I had to pay in full before operation, the insurance company gave me a international forum to fill out
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Old 12-25-2013, 09:29 PM
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jasonhhh jasonhhh is offline
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Quote:
Originally Posted by Jerry5 View Post
jason,
like the others here, can you give some details.

First do you have the international waiver?

You paid all of this upfront?

Did you submit the forms?

What percentage did BCBS cover?

I have BCBS, and should have switched to Aetna, after reading all the fine print, they consider ADR 'investigational'.

This is of course BS.

Everyone should write their Congressman, and ask why the Spinal Kinetics, M6, is not approved for use in the USA, why?

J&J bought DePuy, and it is a cash cow, both the Charite and the ProDisc, are owned by J&J.

Let us know jason, glad to read you have yours.

Jerry
believe me I was surprised myself it took me a couple years to save up for this operation I still cant believe I was refunded without a fight
I don't know about my international coverage but ill find out at a later date,
I paid all cost upfront
BCBS covered 100 percent
I submitted forums from dr clavel to BCBS
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  #9  
Old 12-29-2013, 11:40 AM
2Confused 2Confused is offline
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Congrats Jason!!

I recovered 60% from BCBS after cervical surgery with Dr. Clavel. Am I reading correctly that you received 100% coverage from BCBS? That is wonderful!

Quote:
Originally Posted by jasonhhh View Post
believe me I was surprised myself it took me a couple years to save up for this operation I still cant believe I was refunded without a fight
I don't know about my international coverage but ill find out at a later date,
I paid all cost upfront
BCBS covered 100 percent
I submitted forums from dr clavel to BCBS
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Disk rupture cervical 5-6 & 6-7
2 level M6 ADR, Dr. Clavel - Oct. 2012
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Not a day goes by that without me whispering a silent "thank you" to Dr. Clavel
Post Op 2+ years
Cross Fit 3-5 times a week
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  #10  
Old 12-29-2013, 02:25 PM
Jerry5 Jerry5 is offline
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Thank you for the reply, this is good news.

This Dr Has a lot of experience, so does the team in Germany, ONZ, Bierstadt (SP) so this is a factor in their decision, I emailed the FDA, and they said this M6 is only for Export Sale.

Let us know about the international rider/waiver, I looked at my (BS)BC BS, and it states right there, this is 'investigational' (ADR), what this means, is they don't want to pay.
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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; 12-29-2013 at 02:31 PM. Reason: thought this was Pro Disc
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