How has anyone gotten insurance coverage

[APS]

Cheryl,
That's very interesting - when my previous insurance denied my claim, I only wanted them to cover the surgery because I was trying to get in on the extended ProDisc study, which pays for the disc. But my insurance company at the time would only pay for fusion.
So I suppose you could look into being a part of a study?
Good Luck,
Andrea

[letteski]

On my approval letter for ADR it states:

Procedure: 22851 Apply Spine Prosth Device
Planned Treatment: Anterior Lumbar Artificial Disc Replacement

My insurance is Health Comp/Universal Health Review PPO. UHR is the one that did the authorization.

There is not mention of disc type on the letter. But the doctor that got me approved was a Charite doc. PM me if you have any questions.

[cmarks927]

Thanks everyone for all your information. In order for me to have the surgery tomorrow (which I'm going to do) I have to pay for the disc upfront. The hospital said they would bill United Healthcare and then I could appeal from there. But I must say for $11,500 it better be worth it!!

[JL]

Cheryl, our thoughts are with you tomorrow for your ADR. It will be worth it. Bill

[kristi]

I am trying to get Charite ADR approved by UnitedHealthcare. I am working on getting my letters ready to mail some legislators. Has anyone gotten any response from such letters?

[Kat]

Kristi

I have UHC and I am in the 1st appeal stage. After sending the appeal letter to UHC, I wrote my state and US Representives to not only plead my individual case, but bring it to their attention that this insurance coverage issue of FDA approved procedures needs to be addressed. I got 1 reply from my US representive that was a politically "canned" letter. I also got a good response from my state senator stating he would put in a call to division of insurance, but cautioned that it may not help. Heck, at least he tried and I am extremely greatful for that!
I have yet to hear from UHC regarding their appeal decision and I am kinda hoping that since its been a while, that maybe the company is rethinking their ADR coverage. When I hear from them, I will definitely post the results good or bad.

Keeping fingers and toes crossed!
Kat

[Cat-mt]

Hi all! I agree that we need to let as many people know what is going on as to the insurance not approving ADR. I have an idea, I think it would make more of an inpact if we all emailed montel, ohpra, all of the major tv stations, and who ever else we can think, all on the same day. Just think what getting just one letter a day would be like, they would most likely just toss it in the round file. But if we all wrote, emailed, called all on the same day, can you guess what the reaction would be if they got hundreds of the same subject in one day! it is just a thought, let me know what you all think!
Cathy

[sfmcfar]

Kristi/Kat,

MAMSI, which is owned by UHC, denied my appeal, and I'm pretty sure they never even bothered to read it. In my appeal I told MAMSI that Federal regulations prevented them from classifying an FDA-approved device as "experimental" (this regulation applies to Federal Employee Health Plan carriers) and in their appeal they never addressed this issue - simply regurgitated the "unproven" nonsense.

Next step for me is an appeal to the Office of Personnel Management...

[Melody Beattie]

Re the original question, why the insurance company would pay for the surgery and not the disc, I believe the Charite is the only FDA approved disc; therefore if the disc is another brand, they could deny paying for it on those grounds (non FDA approved). What kind of disc were you asking them to pay for -- or did they just deny across the board?

[cbasham]

has anyone been approved for a 2 level and if so what insurance?