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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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Old 06-25-2015, 03:54 AM
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mhbussink mhbussink is offline
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Default LDR mobi-c patient advocacy program

In case this hasnt been brought up already......LDR has a patient advocacy program now. They are getting approvals for two level mobi-c surgeries for patients. They just took over my case.

Information can be found here: LDR Spine > LDR Reimbursement

They can take your case through the appeal process all the way to an external review. I will post as soon as I have a decision. They have filed a 2nd level appeal for me. They didn't bypass it and go straight to an external review because they are seeing approvals now at the internal level. I was told its not a 100 percent gauranteed that I will get approval. But I do have a much better chance having them represent me.
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C5-C6 decompression/fusion on December, 6th,2017. C5-C6,C6-C7 mobi-c disc ADR on October 16, 2015 by Dr.Charles II. L4-L5-S1 fusion September 2013 by Dr. Charles Edwards II.
Injured back in 2002 training in the Navy Seabees.L4-L5-S1 vertebrate were showing calcification from rubbing against each other with retrolesthesis before I submitted to the fusion surgery in 2013. My neck got bad in January 2015. Moderate & severe degeneration c5-c7 w/spinal cord indentation and nerve root compression.
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Old 07-01-2015, 09:27 AM
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colorado babe colorado babe is offline
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I am sending positive vibes your way that you win your appeal. Last year it took 3 appeals before I won. I wish I had known about this resource when I was fighting.
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1998- Injured neck and back in USAF
2011 - Started experiencing Severe Symptoms, Migranes, numbness, spasms in legs and feet and sciatica.
Feb 2014 - Received upper Lumbar Injection - Severe Allergy to injection
Mar 2014 - MRI of Cervical and Lumbar, protruding disc in C3-7, Herniated Disc in L5/S1, placed on STD and FMLA )
July 2014 - Stem Cell Procedure performed
Oct 20, 2014 - ADR (MOBI-C) at C5-7 and Anterior Fusion at L5/S1 by Dr. Pettine and Dr. Techy
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Old 07-04-2015, 08:21 AM
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jss jss is offline
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mh, thanks for posting. That is great information. Hopefully many others that are wrestling with their insurance can get approvals through that program.

And ... good luck on getting approval for yours.
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C4/5 - ACDF in 2000
C5/6 - ACDF in 2002
C3/4 & C6/7 - M6 ADR, Nov 2009, Barcelona
Conceded defeat to a manifestly disingenuous BCBS-TX in my quest for reimbursement, Jan 2011
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Old 09-25-2015, 09:25 PM
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mhbussink mhbussink is offline
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Default Approval! !!!!

Finally got approved through the help of PAR Mobi-C patient advocacy program at the external level. I'm scheduled for October 16th with Dr.Charles Edwards for c5-c7 mobi-c replacement at Mercy Medical in Baltimore MD. Maybe sooner if there is a cancellation. Over 7 months of fighting. Only 3 more weeks to go....
__________________
C5-C6 decompression/fusion on December, 6th,2017. C5-C6,C6-C7 mobi-c disc ADR on October 16, 2015 by Dr.Charles II. L4-L5-S1 fusion September 2013 by Dr. Charles Edwards II.
Injured back in 2002 training in the Navy Seabees.L4-L5-S1 vertebrate were showing calcification from rubbing against each other with retrolesthesis before I submitted to the fusion surgery in 2013. My neck got bad in January 2015. Moderate & severe degeneration c5-c7 w/spinal cord indentation and nerve root compression.
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