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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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  #1  
Old 02-25-2005, 02:50 PM
Nichole Nichole is offline
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I am so frusterated right now. I just got word that my insurance denied me again. Af the 180 page appeal I sent them. I sent them every piece of information out there that I could find. I dont know what to appeal with next. I have tried to be positive, hopeful and everything and right now I feel so angry. I dont know what to do. The medicaitons that I am on are creating so many other problems for me. Plus they arent working that well anymore.

OH I just want to scream. It's so fusterating that my well being is in the hands of my insurance company.

Anyway, thanks for listening.
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Nichole
Seattle,WA

ADR June 15, 2005 WOOOO HOOOOO
Herrniated L5-S1, Tear in Annulus
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Old 02-25-2005, 04:23 PM
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Harrison Harrison is offline
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Sorry Nichole! Were you able to learn more about the appeal process and other options? E.g., many insurance companies allow (and have relationships with) arbitration firms who act as a "quasi-objective" mediator to hear the appeals. Just a thought, as it's worked for some people...

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"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
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  #3  
Old 02-25-2005, 07:18 PM
Nichole Nichole is offline
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Yes I have. That will be my next step if they deny at this appeal. Thank you for the suggestion.
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Nichole
Seattle,WA

ADR June 15, 2005 WOOOO HOOOOO
Herrniated L5-S1, Tear in Annulus
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  #4  
Old 02-25-2005, 08:05 PM
JL JL is offline
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Hi Nichole,
I was concerned when I did not see any news from you after you came out of the hills. The denial is not good. I feel like we are in a head to head race, what happens to you will likely occur to me. But I am not even at the denial stage yet. I am still in the abuse category. Is there an insurance commissioner who would support you when presented with the facts? I sent you a little more XX. (JL)
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(Bill) 14 yrs L5-S1 pain & tear
Discography 2003 DDD
10 yrs. chiropractic
6-14-05 L4/5 & L5/S1 Prodisc Yale New Haven CT Dr. James Yue
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  #5  
Old 02-25-2005, 09:10 PM
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Cindee Cindee is offline
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Nichole
Hi, I just wanted to know whats their reason for denial? I have had the surgery, been approved and I work at an orthopedics office getting authorizations for work comp. for others to have the same surgery. So maybe I can be of some help. Ill check back.
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Back pain began Jan 18th 2000 no trauma
MRI revealed severe DDD L5 S-1 with a 7mm disc bulge
Microdiscectomy/Lami Oct 12th 2000
Leg pain resolved, but back continued to be painful
Neck pain began Feb 2003 no trauma
MRI revealed DDD level C6/7 with a disc bulge
C spine fusion done on Aug 14th 2003
Still needed lumbar 2 level fusion, ugh
Met Dr Rick Delamarter, entered trial
2 Level Prodisc completed Aug 12th 2004
Now (2011) experiencing numbness and heaviness of both legs
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  #6  
Old 02-26-2005, 01:55 AM
Nichole Nichole is offline
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Hi Cindee, They are denying with the reason they are saying it is "investigational". They said "after reviewing the FDA's response to the approval of the Charite' Disc, the FDA stated that they do not know the long term outcome and effecacy(spelling) of the disc". Until they have this information they will continue to say it is "investigational". My insurance is Regence which they are part of BCBS. They are reserving the right to make their own determination about saying the disc is investigational or not. I would be happy to email you my appeal letter and see what you think. Email me with your email and I will reply with a copy of it.

I think it is redicilous for them to continue to say it's investigational. ITS NOT FOR DANG SAKE!!!! I wouldnt be so upset if they atleast came up with another excuse. A new one, you know?
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Nichole
Seattle,WA

ADR June 15, 2005 WOOOO HOOOOO
Herrniated L5-S1, Tear in Annulus
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  #7  
Old 02-26-2005, 06:18 PM
NCFUSED NCFUSED is offline
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Have you appealed to your state insurance board yet????? That is usually "The Supreme Court" on the matter....

John
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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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  #8  
Old 03-01-2005, 07:35 PM
cervie queen cervie  queen is offline
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I really think it's time for all of us to pitch in and help. If each of us would draft a letter to our congressmen, including state representatives, maybe it would accumulate. Too bad we couldn't hire a lobbyiest. Would anyone like to draft a letter that we could cut and paste? In the meanwhile, write a note to your congressman. You can find the address here:

http://www.congress.org/congressorg/home/

Hilary
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  #9  
Old 03-01-2005, 07:49 PM
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Harrison Harrison is offline
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I'd love to help with the letter and an online petition, but I am swamped right now...members?!

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"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
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  #10  
Old 03-01-2005, 08:57 PM
DWebster DWebster is offline
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I think this is a great idea, I was thinking on the same lines earlier. I am afraid that my writing skills are not the best but I believe I have so me good ideas I would love to share, In fact I just wrote an e-mail to a radio personality up here that is very influential. I would like to present him with all the information we can. Paul W. Smith's talk show can be heard by going to www.WJR.com he is on in the mornings 5:30 to 9:00. The insurance companies are causing so many people to live in pain and cuasing them to spend the money they have put aside for retirement, it is just not fare. All the politicians are saying that we need to bring down the cost of health care, this is a good way, Employers are say they need to cut down on work hour lost do to illness, again this a good way. From almost any angle you look at this it is better than fusion!!! I guess I am sounding off again. Any how I think it is time for us to unite and fight back!! Hell lets march on the White House!!!! You think we could get there attention them? A bunch of people in wheel chairs rolling back and forth!

All opinions expressed here are mine and not of this station.

Dave
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87 Lam 88 Lam no help. 11/12/04 was told I needed fusion at 2 levels L4/5 & S1/5, ADR Surgery date was 5/13/2013 with Dr. Bertagnoli had fusion on S1/L5 and ADR on L5/L4. it is now 8 years post surgery and do not even take an aspirin for my back.
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