ADRSupport Community  

Go Back   ADRSupport Community > General Discussion > Insurance Hell

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.


Reply
 
Thread Tools
  #1  
Old 09-14-2018, 08:35 PM
ouchtear ouchtear is offline
Junior Member
 
Join Date: Feb 2015
Posts: 14
Default Has Any successfully appealed a denial in BCBS

I know that some have put in International claims and been reimbursed.. But has anyone been denied Lumbar ADR wrote a appeal and Won?? specifically NY but I would like to know any state.. It would be nice to have a list of Pre-approvals for all states for BCBS too.. Maybe this is already somewhere on the site that I have missed too... Thanks.. I am going to try for the second time in 3 years write a Appeal.. I am reading Laurie Todds book too.. If anyone has a good sample appeal that would be great too.. Of course a successful one would be golden..
__________________
ActivL l5/S1 2019 at TBI
Reply With Quote
  #2  
Old 09-20-2018, 04:06 AM
tijeladeacai tijeladeacai is offline
Junior Member
 
Join Date: Jul 2017
Posts: 12
Default

PPO or HMO?
__________________
_________________________
06.12.2017 - microdiscectomy
04.25.2018 - DEXA bone scan performed showing mild osteopenia -1.7
08.16.2018 - L4S1 ADR - LP-ESP performed in Germany
Reply With Quote
  #3  
Old 09-20-2018, 11:09 PM
ouchtear ouchtear is offline
Junior Member
 
Join Date: Feb 2015
Posts: 14
Default

Any? I would like to see a written appeal example that actually worked.
__________________
ActivL l5/S1 2019 at TBI
Reply With Quote
  #4  
Old 09-28-2018, 10:57 PM
megatron-adr megatron-adr is offline
Junior Member
 
Join Date: Jul 2016
Posts: 8
Default

My journey to get two level Mobi-C pre-approved through insurance was an absolute nightmare. The first submission for pre-approval with Anthem went through the Peer-Review (denied). The surgeon had me use a 3rd party appeal consultant that was sponsored by LDR (mobi-c mfg at the time) to attempt to get the appeal through and that 1st Level Appeal was rejected also. I was debating whether to go forward with the Final Appeal, but then decided to go visit TBI in Plano and see Dr. Blumenthal.
My thought was I would likely end up having to pay out of pocket for the surgery and they were the most experienced and reasonably priced here in the US as best as I could tell at the time (late 2016). Ultimately he thought there was no reason insurance should not approve this and his office submitted for pre-approval. It was approved within a week after a two months of constant follow up and jumping through hoops with the other submission and appeal process. Long story short.... sometimes it is not the procedure that is getting rejected, but I think it is the hospital system or the way the claim is written up that triggers a rejection.
My lesson learned.... if insurance declines it through one system... try a different system with a different surgeon. It is interesting how things sometimes workout for the best as I truly beleive I was meant to get the surgery at TBI by Dr. Blumenthal vs the original (closer to home) location.
Reply With Quote
  #5  
Old 09-28-2018, 11:09 PM
megatron-adr megatron-adr is offline
Junior Member
 
Join Date: Jul 2016
Posts: 8
Default

One other note... the policy on two level ADR at Athem had just been updated in August of 2016 as not being considered experimental and was an option available in my plan as long as you met all the bullets that made it medically necessary. I am not sure about your plan, but if it is not even in the policy for being covered as a medically necessary option then that is a whole different battle. I know the last time I checked cervical ADR was much more adopted as medically necessary than lumbar ADR. I don't think too many US insurers are onboard with lumbar ADR yet.
Reply With Quote
Reply

Bookmarks

Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off


Similar Threads
Thread Thread Starter Forum Replies Last Post
Anthem BCBS denial overturned at external review mhbussink Insurance Hell 3 10-08-2015 08:51 PM
BCBS reversed their denial and paid for multi-level cervical ADR!! cruiser Insurance Hell 3 04-08-2014 09:44 PM
Has anyone appealed to Unicare for ADR? April Insurance Hell 3 05-23-2008 10:00 PM
Appealed and denied The Big File 7 10-26-2005 03:50 AM


All times are GMT -4. The time now is 10:15 PM.


© Copyright 2006-2017 ADRSupport.org All rights reserved.