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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 08-17-2010, 11:16 PM
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nornie73 nornie73 is offline
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Join Date: Jun 2010
Posts: 22
Default Get insurance approval? or pay cash now and hope for reimb. later? help!

My husband is looking at having 2 art. cervical discs implanted ASAP. We have a local northern CA HMO (which does have positive coverage for one level--may not be approved if 2 level or hybrid). In any case, he is looking at going to someone with a lot of experience (LA, Texas).

TBI has given us a firm cash quote. Should we just go ahead and pay this and get the surgery done and try to get reimbursed later? Or try to go the approval process and wait and see? My fear is that it will take forever and then be denied anyway. But if we pay the cash price does that eliminate any chance of getting reimbursed later? TBI seems to be the only one who can manage to put together a price quote.

Anyone had luck paying cash and getting a payment later from insurance? This is all so confusing...guess I need to buy the Insurance Warrior's book (if it addresses this!)

Thanks for any input.
Husband Bob's injuries:
'95 L5-S1 Micdrodiskectomy: successful
2010 Lumbar pain returning, then rear-ended
on freeway in Sept '10 resulting in herniated C5-6 and C6-7.
9/23/10 Prodisc C5-6, Fusion C6-7 (already autofusing + osteopenic) Thanks to a brilliant, seasoned surgeon who always puts outcomes ahead of fantasy! God Bless you Dr.Lauryssen!
6/25/11: still suffering with debilitating pain in between shoulder blades..will this ever go away?
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Old 08-18-2010, 10:39 AM
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jss jss is offline
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Join Date: Nov 2009
Posts: 1,411


I have thus far not had luck in getting reimbursed after surgery. I'm in the process of my second appeal and do believe that if I'd done the insurance fight before surgery that I would have had a better shot at getting my carrier to pay.

Good luck, Jeff
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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