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The Big File All issues not easily categorized in the above forums are here. Comments on general health, diet, "getting comfortable," and more are here. |
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#11
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Nichole,
Sorry to hear about your denial. I am at the same stage you are - the independent external review. I decided to forego the in-house appeals and grievance committee, realizing no way was I going to change the minds of those on the insurance company board that ADR isn't experimental. Unfortunately from your experience, looks like that may have been right. I'll keep you posted on my next step. Andrea
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Andrea Grand Junction/Denver, CO Failed L4-5 diskectomies '93 & '00 ADR originally scheduled 3/9/05; dropped insurance appeal due to new job; new insurance UHC |
#12
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Thank you everyone for your words of encouragement. This is definatley a very tiresome, long battle. The positive side of things is there is only one more appeal left. The battle is almost over either way the decision goes. I am trying to stay focused on the positive in any way possible I can twist it to be so.
This morning I also found out some interesting information about the doctor who was on the panel. The panel consisted of 1 doctor (who is a Radiologist migh I add), 1 RN and 1 "admin" person. This morning at work I was looking thru the Regence Blue Shield Provisions Newsletter that comes out periodicly and who's picture do I see inside. Dr. John Boyes, the physician on the panel yesterday. His picture is next to an article titled "Medical Policy and Contract Language". Guess what his title is at Regence.........Physician Ombudsman. He forsees the Medical Policy. So......another words......he wasent on the panel yesterday acting as a Physician....he was there to defend or uphold the medical policy. Very frusterating. Again, thank you all for the support, it truly helps.
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Nichole Seattle,WA ADR June 15, 2005 WOOOO HOOOOO Herrniated L5-S1, Tear in Annulus |
#13
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Nichole,
I am very sorry to hear this did not go your way. I hope your last battle with the independent panel has a better outcome for you. I know how much you would rather have this ADR than fusion and it pains me to see you settle for something that you know is inferior. Being from Seattle also and having Blue Cross also, I don't feel much optimism about my situation either. May God comfort you in these trying times.
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*10 plus years of back pain *'99 first MRI shows L4-5 bulge *'04 MRI shows L4-5 grade 3 annular tear & rupture with moderate DDD *'05 Discogram shows concordant pain at L4-5 *8/18/05 scheduled ADR surgery participant in Kineflex/Charite study |
#14
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Nichole,
I totally understand your frustration, the Physician that denied my initial claim was a diabetes specialist and my second appeal was denied by a Social Worker in their appeals dept. US Healthcare is in a really sad state....
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John Greensboro, NC DDD L5-S1 Lost all ADR Appeals w/ UHC PLIF Fusion L5-S1 on 5/17/05. Pars Defect L3-L4 DDD L3-L4 L4-L5 3 LVL Fusion Scheduled 4/08 |
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