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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 02-22-2014, 07:34 AM
bwink23 bwink23 is offline
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Posts: 262
Default Attempt at Direct billing by BlueCard WorldWide

So as i was checking out of Quiron Hospital, Yolanda who is Dr. Clavel's head secretary informed me that BlueCard WorldWide for BCBS insurance attempted to get my medical reports, itemized billing and such. I verified coverage with them before embarking on this venture and was instructed to mail all reports and billing to it's national service center in Florida. The person who requested my information i never spoke with. He's a representative with AXA Assistance USA based out of Chicago. When i called BlueCard Worldwide prior to my travel, they gave me a case number to hold onto in case i had any questions. The rep did mention they would call the hospital to "make sure the surgery went OK", but no allusions to getting all my reports. Think they told a little white lie.

Yolanda could not give this information without prior consent from me. You would think the insurance companies would know things like that by now. I was never instructed by BCWW representative that anyone would be trying to directly get my surgical information. It was all understood that i would be mailing in the medical reports and itemized billing to their Florida center address. I do have a copy of the fax sent by AXA ASSISTANCE USA to Quiron Hospital with my case # given to me printed on the sheet.

This is for those who have this insurance that get prior verification of their coverage benefits for out of the country medical procedures. I think i'm the first one they've tried doing this to. Yolanda was surprised that they requested my information directly, as all their international patients mail in their reports and billing themselves. Maybe BCBS was just trying to expedite the claim...not quite sure what to think about it. I told Yolanda to not fax them anything and if they contact her to tell them i will be mailing in the information myself. Keep in mind, i still paid for this surgery all up front and will be trying to get some reimbursement.

I hope i'm not looking too much into this. More like i'm hoping this is a step in the right direction for insurance companies to take their services more globally and give us patients more freedom to choose without having to jump through all these hoops, and then hope to the good heavens that we see a good chunk of your hard earned dollars come back in our pockets. This is not quite direct billing since i had already paid upfront, but getting pre-authorization with direct billing could be coming in the near future.

__________________
2013 - MRI and CT scan....DDD L4-S1
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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  #2  
Old 03-12-2014, 07:51 PM
Jerry5 Jerry5 is offline
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Join Date: May 2013
Posts: 363
Default BC

BC International,
Not sure this is the same, but the address I sent to, was in Miami.

This is for the pre-authorization billing, Insurance might as well get used to it, we pay a LOT of money in premiums, enough that in 3 years or so, we will pay for the surgery, this is combined, my contribution, plus the company portion.

Ridiculous, they get all this money every year, then want to deny surgery and medical devices that will allow people to get 'back on their feet'.
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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.
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  #3  
Old 03-30-2014, 11:33 PM
cruiser cruiser is offline
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Default

I went the BCBS worldwide route as well.

I was told everything was fine, received, and was being processed....months passed only to be denied.

I then filed almost 40 pages of data to BCBS-Texas and won my case on the first appeal
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C 3-4-5 fusion circa 1981
2 Spinal Kinetics M6-C's at C 5-6 and C 6-7
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  #4  
Old 03-31-2014, 10:49 AM
Jerry5 Jerry5 is offline
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Posts: 363
Default Appeal,

cruiser, you won the appeal, and had two M6C, where were these put in, and can you name the doctor, mine is lumbar, but if in the US, would be a good reference.

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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.
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  #5  
Old 03-31-2014, 07:27 PM
cruiser cruiser is offline
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Default

I went to Stenum near Bremen Germany, the implants are at C 5-6 and
C 6-7. The surgery and treatment there was first rate. I already have a 30 year old C 3-4-5 osseous fusion, to complement the new hardware.
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C 3-4-5 fusion circa 1981
2 Spinal Kinetics M6-C's at C 5-6 and C 6-7
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  #6  
Old 03-31-2014, 08:09 PM
Jerry5 Jerry5 is offline
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Join Date: May 2013
Posts: 363
Default Glad to hear this...,

Could you outline your appeal, just list the items you used in the appeal.

Procedures, Medicine, length of pain, other therapies tried...?

Did you get Pre-Authorization?

Was your Treatment plan more than one level, 'for Pre-Authorization?

What percent did they pay, was this negotiated at all?

(If you would like, send private)

Sorry for all the questions.

How long ago was this and how are you doing?

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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; 03-31-2014 at 08:22 PM. Reason: more info, grammar
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  #7  
Old 04-07-2014, 11:55 AM
cruiser cruiser is offline
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Join Date: Jan 2014
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Default

Could you outline your appeal, just list the items you used in the appeal.

-I used "Google Scholar" and regular google to parse through vast
numbers of medical journals, articles, white papers, research papers, opinions by neurosurgeons and orthopedic surgeons. I put together a cover letter, table of contents, an about 40 pages of documents that I had printed at Office Max and bound with a cover. All pertained to the benefits of multilevel ADR's and opposition to fusion.

Procedures, Medicine, length of pain, other therapies tried...?

-I tried various meds for relief, they just masked the pain. I have had issues with the deterioration of the discs as my C5-6 and C 6-7 started contacting each other. ie. severe foraminal stenosis, and central cord
stenosis.

Did you get Pre-Authorization?

-I tried and was denied due to arcane FDA regs and my policy. However when I learned that the insurance Co, would pay to have my entire cervical spine fused into a solid block of bone that gave me impetus to fight.

Was your Treatment plan more than one level, 'for Pre-Authorization?

-No. Not for ADR. But BCBS would gladly pay for a hybrid-construct of total fusion. ( Note: I already have a C 3-4-5 fusion )

What percent did they pay, was this negotiated at all?

- I got 100% coverage minus a small copay. I did foot the entire cost of the plane tickets for myself and my beautiful companion.

(If you would like, send private)

Sorry for all the questions.

How long ago was this and how are you doing?

- I had the operation in September of 2013. I am well except for some residual nerve damage that was affecting my right arm and shoulder before the operation. I am hoping that time and exercise will help. I have had no issues at all with the M6-C's, the operation, or the incision.


-Regards !! "Cruiser"
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C 3-4-5 fusion circa 1981
2 Spinal Kinetics M6-C's at C 5-6 and C 6-7
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  #8  
Old 04-07-2014, 12:55 PM
Kelly4ADR's Avatar
Kelly4ADR Kelly4ADR is offline
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Default Copy of appeal

Jerry5,

Andi Lea has bcbs and won the appeal. She was very kind in sending me a copy of her appeal, and I'm sure would forward a copy to you as well.
__________________
2004 MRI -cervical bone spur causing pain
2011 MRI -5 bulging discs at C3-7: Recommended C5-6 and C6-7 for a two level fusion, I said no thanks.
2014 MRI -progressive compression C5-7.
MRI 6/5/14- Ruptured L4-5, bulge at L2-3 and L5-S1 Dr recommends discectomy of L4-5 but won't do surgery until cervical is stable
8/2014- 8 months/3 rounds of appeals, Aetna denies 2 level cervical ADR
2 level ADR w/ mobi-c C5-7 Jan 7, 2015
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  #9  
Old 04-08-2014, 09:36 PM
Jerry5 Jerry5 is offline
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Join Date: May 2013
Posts: 363
Default Appeal

Kelly, thank you, She sent to me already, I am getting ready, most likely, when I have more energy, this weekend, I will put together a binder as cruiser suggested, this can only get worse,

They deny, deny and deny, if the put the M6 in the first place, this would not be dragged out and cost DOUBLE.

Thank you to Cruiser and Kelly.

btw, I am looking at three level, L23, L45 and L51, I am sure they are having a fit.
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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; 04-08-2014 at 09:38 PM. Reason: add'l info
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