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 11-25-2008, 07:40 PM
trkdoc714's Avatar
trkdoc714 trkdoc714 is offline
Senior Member
 
Join Date: Nov 2008
Posts: 137
Default Insurance getting easier?

I've been working with Aetna for a few days now. They're leaning toward helping but I can tell they'll push back somewhat.

My company is self insured and Aetna manages the plan. I contacted our insurance specialist (the same one the forgot to pay me disability payments for 3 months) and she's trying to help with our company's position. With both entities on a conference call, our rep urged the Aetna rep to find the coding for the ADR surgery. She then had him transfer us to a specialist to locate an ADR surgeon in the US. I'd imagine I'll have to sell the cost savings of an operation in Germany as opposed to a domestic (much higher priced) procedure.

It's not much, but it's a start.
Reply With Quote
  #2  
Old 11-26-2008, 06:41 PM
Harrison's Avatar
Harrison Harrison is offline
Administrator
 
Join Date: Oct 2004
Posts: 6,883
Default Codes

For what it's worth, we've talked about codes many times, here's one old topic here, which does contain some codes. I believe they are still valid.

PS: please insert a signature (brief history) when you can.
__________________
"Harrison" - info (at) adrsupport.org
Fell on my ***winter 2003, Canceled fusion April 6 2004
Reborn June 25th, 2004, L5-S1 ADR Charite in Boston
Founder & moderator of ADRSupport - 2004
Founder Arthroplasty Patient Foundation a 501(c)(3) - 2006
Creator & producer, Why Am I Still Sick? - 2012
Donate www.arthropatient.org/about/donate
Reply With Quote
  #3  
Old 11-26-2008, 11:47 PM
keziah23's Avatar
keziah23 keziah23 is offline
Senior Member
 
Join Date: Oct 2008
Posts: 104
Default

I have the aetna codes if you need them, just went through this and got my surgery done. PM me and i'll give you what I have.
__________________
Timeline:
1988:sprained neck roller skating
1989:dislocated neck in a freak accident
1993:MVA
1995:diagnosed with bulging disc C5/6
2000:disk herniated
2000-2004:multiple treatments including nerve root block, trigger point injections, epidural steroid injections, pt
2005-2008: pain meds and muscle relaxers only
ProDisc-C replacement on c5/c6 11/18/08
Reply With Quote
  #4  
Old 11-28-2008, 10:09 AM
trkdoc714's Avatar
trkdoc714 trkdoc714 is offline
Senior Member
 
Join Date: Nov 2008
Posts: 137
Default Aetna codes

Thanks to you both for the offer of the codes. I found them on the Synthes site and forwarded them to Aetna on Wednesday. They also located 3 surgeons in our area that use ADR technology. Unfortunately for me, they only perform the cervical procedure. My wife is excited though. She's going to schedule an appointment with the head of Emory Spine. He's also a teaching orthopedic professor at Emory University here in Atlanta.

My wife went by the last ortho clinic to pick up copies of my last X-Rays and lowered dosage prescriptions for Percocet. Instead they gave her the medical notes from day one. After reviewing them several times, it looks like after my original surgeon left the clinic, I've been treated by Moe, Larry and Curly Joe.

None of the ensuing surgeons/ consultants referenced any disc level except L5/S1. The pain management doctor has been treating me per their diagnosis.

It looks like I get to start over. I think that's for the best now that I'm much better educated, have a lot of support and will be able to better understand the disease, treatments and FDA/ insurance imposed limitations.

Thanks again,

Bob
__________________
04/06 L5/S1 Rupture
05/06 MRI shows DDD @ L2-S1
06/06 Diskectomy/ Laminotomy L5/S1
04/07 Recurrent Disc L5/S1
4 Ortho and 1 Neuro Surgeon, 5 MRIs, 1 EGM, 1 Myleogram & 11 EDIs later:
03/27/09 L4/5 & L5/S1 Maverick disc at Stenum
Reply With Quote
  #5  
Old 12-01-2008, 09:54 AM
KBear's Avatar
KBear KBear is offline
Senior Member
 
Join Date: Sep 2008
Posts: 163
Unhappy Lost in Translation

Quote:
Originally Posted by trkdoc714 View Post
Instead they gave her the medical notes from day one. After reviewing them several times, it looks like after my original surgeon left the clinic, I've been treated by Moe, Larry and Curly Joe.

It looks like I get to start over. Bob
That sucks that your information got "lost in translation".
Isn't it amazing what you fiind out in those medical records, mine had all sorts of surprises (the big one being that I did have DDD and they acted like they just didn't understand why I was in soo much pain) I know my switching of doctors and starting over (for the 3rd time) is what has led me to hopefully having ADR soon Hopefully, by starting over, you can get the treatment you need in a timely manner and it will turn out to be a good thing
Best Wishes, Kathy
Reply With Quote
  #6  
Old 12-09-2008, 06:50 AM
trkdoc714's Avatar
trkdoc714 trkdoc714 is offline
Senior Member
 
Join Date: Nov 2008
Posts: 137
Default Doctor change

I'm kind of curious what the resonse from Aetna will be when I ask them why their expert(s) authorized payments for procedures that didn't address the correct levels.

As far as I'm concerned, Aetna is as much at fault as the last three surgeons and myself. I really should have taken control of my records and treatments a long time ago.

I hope your third doctor is the one that turns it around for you.

Bob
__________________
04/06 L5/S1 Rupture
05/06 MRI shows DDD @ L2-S1
06/06 Diskectomy/ Laminotomy L5/S1
04/07 Recurrent Disc L5/S1
4 Ortho and 1 Neuro Surgeon, 5 MRIs, 1 EGM, 1 Myleogram & 11 EDIs later:
03/27/09 L4/5 & L5/S1 Maverick disc at Stenum
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



All times are GMT -4. The time now is 07:52 AM.


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