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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 02-21-2020, 10:03 AM
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Sturrgeon Sturrgeon is offline
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Join Date: Feb 2020
Posts: 5
Default Fighting insurance

Hi all, any advice, links or info on fighting insurance for approval of a single level ADR? Currently I have exhausted two internal appeals with UHC and they continue to come back with denial for the procedure. They have given me three different explanations now for their denial even though I have met all their requirements for approval.

Should I move forward with the external appeal process as a next step? From what I understand any legal/court battle would only result in the insurance company approving the procedure at significant legal costs to myself. Insurance companies are covered under ERISA LAW.
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Chris Sturr
Herniated L5-S1 2011; managed through conservative treatment to present
Current Condition: Single level DDD at L5-S1 with chronic bilateral radiculopathy; pain 24/7
Seeking surgical fix, preferably ADR via the ActivL Implant System
Insurance Status: Denied UHC; currently fighting
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Old 02-21-2020, 02:03 PM
Cheryl0331 Cheryl0331 is offline
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Join Date: Dec 2010
Posts: 747
Default United (not so united) Health Care (not so much care either)

They are notorious for non approval.
I would invest your money in the procedure and not in court.
Good luck!
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52 yr old 5ft.7in. 139 lbs. non-smoker conservative treatments failed
2007 fusion C4-6 w/peek implants plate & screws, failed due to long term use of cox-2 inhibitor
2008 revised w/donor bone replace plate & screws
2009 fusion Roi-C C3-4
2015 MRI & CT shows incomplete fusion, significant central canal narrows C3-4, mild posterior spurs C4-6, mjr ddd C6-7, segmental kyphosis at C7-T1 2-level ADR with Dr. Clavel
2019 some ddd C2-3 occipital nerve pain , HO behind ADR C6-7.
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