List of Who has been denied ADR

[Terry]

Blue Cross/Blue Shield of Michigan payed for my four-level ADR surgery that I had done in Germany in November 2006. They payed for it in January 2007 less than 2 months after the surgery.

Good-Luck to you in your fight. I have no regrets in getting the surgery done.

Terry Newton

[GaryC]

I have been denied by TRICARE - not an insurance company, but a branch of the Federal Government. That's the same Federal Government that the FDA belongs to - the FDA that approved ADR for single level.

I was originally denied in April 2008, appealed, denial upheld in June 2008, appealed again, policy review concluded in November 2008 that ADR is "unproven technology."

[kimmers]

I am sorry, Gary.
I know how frustrating it is when the insurance company/gov't agency denies you. You tell them this procedure is FDA-approved, it has gone through testing, it is not experimental and it is better for you according to your doctor.

You want to shout from the roof tops and it is such an unbelievable feeling that something like this can happen.
I don't know what to tell you. I have had a very long protracted insurance fight against Blue Cross of California and I don't consider my fight over because there are so many people who can benefit from ADR, who are candidates.

In my case, I just could not stomach having a procedure that my doctor did not recommend highly and that most likely would lead to adjacent disc disease.

Kimmers

[ERvet]

Yep, count me in as one of the Anthem/Blue Cross denieds. Single level, Prodisc, L5-S1, deemed "experimental" yada yada yada. I've postponed the fight for now, looking into non-surgical options. My doc said things may be starting to ease up in TX and CA with regard to Blue Cross, but I live in CO. Though the company is Anthem Blue Cross of CA.

Susan/ER Vet

[kimmers]

Susan,

You were unlucky to have the wrong insurance company. Sorry. See Insurance Hell. Tomorrow I get to be interviewed briefly for a public radio program in San Francisco. It is taped and I will give them a mouthful for our great insurance company, but probably will not be allowed to say their name. But, boy would I like to.

Kimmers

[Sandra L]

Add me to list although not exactly denied. Not Workers Comp, just old age and prior accidents. Paid out of pocket to go to Germany. We called Anthem BCBS after my surgery was completed, didn't get a pre-approval. They said they would cover it, just send invoices. ADR, four cervical levels, ProDisc.

Received a check for $98 towards my ADR within 45 days. Along with the check was another letter saying they needed a breakdown on costs by day and $ amount before they could pay more. Pro-Spine broke down my treatment each day, but didn't place individual amounts for each item. Before I received this information, I got another letter from BCBS that the previous payment from them was an error. Needed to submit bills to Medicare first. Once I get the denial from Medicare I am to resubmit all bills to Anthem BCBS. I'm not going to hold my breath. Wonder if I have to pay back the $98 they sent?? LOL

Sorry for being redundant, added same info to another thread. I get confused too may threads along with senior moments. Sandy

[rhatzy]

united health care administers the health insurance for American Airlines. They are self insured and I am a pilot for them. A major cause of sick leave by pilots is back problems and they have a lot of them that have been out for a while and paying them disibility and benefits. Also they are now paying someone else to do their job. So, when they heard about me, they became very intrigued with this procedure because I have two levels done and am back at work. I am the only pilot at American with these discs.

The medical department at AA is very interested in my successful outcome and has been talking with the company about this "new procedure" and may just reimburse me. First they wanted me to appeal the first denial just to have the paperwork and I have done that. Just did that last week and maybe, just maybe, I will get reimbursed. So, there is hope out there.

Mark

[KBear]

Originally Posted by kimmers

I have had a very long protracted insurance fight against Blue Cross of California and I don't consider my fight over because there are so many people who can benefit from ADR, who are candidates. Kimmers

Kimmers,
Did you get it paid for?

[KBear]

I have also been denied by Unicare (Texas). It is a self employed policy, that sucks, even though we pay a fortune for it $750 a month for a family of four. Since we are self employed, it is either pay it or go without; all the self employed policies suck. Some of them are doing away with deductibles less than $2500 per person; which is nuts. Guess I am stuck with mine forever, seeing as no other company will accept me without a pre-existing cause excluding my back.

[kimmers]

Good News KBear, at least I think it is.

I found out in my battle with BC that lawyers will take contingency cases against Ins companies for bad faith if you have individual policies, that are not part of an employee group policy.
Appeal and see how you do. Write down every conversation you have with ins company and the date and time and who you spoke to.
Laurie--the insurance warrior--gave me a few tips and I think they are listed on this board if you go to her threads.
My last appeal was about 200 pages. I think i included three instances where BC paid for the exact same surgery for other people.

Send everything registered mail. Found cheaper at post office than a post place.

Kimmers