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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 07-06-2005, 02:24 PM
Julaine Julaine is offline
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Is there anyone who has gotten disc replacement approved by Blue Cross? right now i am in the appeal process and I really have no hope of it coming through. I have no life right now. My kids summer is just going to be H*** for them with a 31 year old mom in bed who is good for nothing. I am slipping into depression and the pain is unbearable. I dont know what to do. I had a medial branch block and transforaminal epi done yesterday and the pain is just excrutiating.

Julaine
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Back pain 16 years Chiropractic care 1993-1994DX 2003 DDD at L4 5 S 1January 04-Nov 04 Epi Injections October 04- March 05 Morphine, vicodin, Duragesic, June 05:Blue cross denied my two level ADR
august2005 woke up and had no feeling in legs was in
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  #2  
Old 07-06-2005, 04:46 PM
mross mross is offline
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Juliane,

I have a PPO plan with Blue Cross Blue Shield of Delaware and they approved my single level on the first try. I was prepared to have to appeal and was shocked that they approved so quickly. Maybe this is a positive trend with BCBS. Best of luck to you.

- Meredith

ADR at L5/S1 scheduled for 7/20/05
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  #3  
Old 07-06-2005, 07:19 PM
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Harrison Harrison is offline
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I did -- but I went through hell to get approval by BCBS of Mass. That's why I call them Blue Corpse Blue Sled, it makes me feel better to be silly about their policy, which is inconsistent and draconian.

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  #4  
Old 07-06-2005, 08:47 PM
ans ans is offline
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I've heard that BC in CA (maybe dependent on region) both denies and pays for ADR's. Go figure..

All I ever got were bs responses (non-answers) from Utilization Review.
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Severe, extensive DDD, considered inoperable by Dr. Regan, Lauressen, & some guy at UCLA. Severe foraminal stenosis (guess they can't operate!) and some spinal cord compression that Lauryssen would fix if gets outta hand.
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  #5  
Old 07-07-2005, 06:59 AM
Rein Rein is offline
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Julaine

I'm really sorry for the troubles you're going through. You'd think getting medical help would be easier, but the sad truth is, it just isn't. Keep your chin up and keep plugging. Your solution is out there, if you can persist long enough to find it! Tomorrow's a better day!

There's more than one thread in this forum specifically dealing with Blue Cross. Search "blue" or "bcbs" or "bc/bs".
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03/09/26 - Ruptured L5-S1.

Years of pain, discectomy, research into anatomy, hardware, clinical trials, facilities, surgeons, techniques, insurance. Attempts at ProDisc, Activ-L trials. Now, low bone density. D'oh!!!

At 61 years, no longer qualifying for trials due to my age (chronological, not physical or mental).

2009 - Working on improving bone density or getting rich so I can go to Germany, where medicine and insurance have gone beyond the Stone Age.
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  #6  
Old 07-08-2005, 01:14 AM
paulam310 paulam310 is offline
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Julaine, I have Blue Cross PPO and they approved my three level cervical adr within a week. Maybe certain doctors are having more success by billing it in a certain manner, I really don't know. Even before the doctor's office called my insurance the accounting department told me how much BC would probably pay, they obviously have had experience with BC paying for ADR surgery.
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  #7  
Old 07-10-2005, 03:42 PM
Rein Rein is offline
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Julaine

I've reread all your posts and the one thing you don't talk about is the possibility of going to another doctor. It's obvious your current surgeon's office staff is not experienced at getting BCBS to pay for ADR, pain meds, etc..

You can see from some of the above posts that BCBS in California *will* sometimes pay for what you need, but you have to get connected with a surgeon who has a history of success in this area. Dr. Delamarter in Santa Monica *is* that surgeon and if you are at your wits end and get to the point where the extra trouble of traveling doesn't seem so bad anymore, then I strongly recommend you at least call his office and talk to the billing clerk or person who deals with insurance billing. I'm sure that person could ask you a few simple questions about your condition and insurance coverage and give you a definitive answer immediately.

Of course, you may have a local BCBS coverage which is not exactly the same as the others who posted above, but it's certainly worth exploring! Please let us know what you find out, OK?
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03/09/26 - Ruptured L5-S1.

Years of pain, discectomy, research into anatomy, hardware, clinical trials, facilities, surgeons, techniques, insurance. Attempts at ProDisc, Activ-L trials. Now, low bone density. D'oh!!!

At 61 years, no longer qualifying for trials due to my age (chronological, not physical or mental).

2009 - Working on improving bone density or getting rich so I can go to Germany, where medicine and insurance have gone beyond the Stone Age.
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  #8  
Old 07-10-2005, 04:04 PM
Julaine Julaine is offline
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This is the fourth surgeon I have seen. I have connected with quite a few other people in his office that blue cross has covered for. I have sent Blue cross all my MRIS and reports from every other dr who says I need ADR.
I dont know if it is just hit and miss with them or what. because my surgeon has done quite a few ADRS and all of them had Blue cross. I slipped and fell friday night and ended up in ER. they would do nothing for me and it was the worst experience i have ever had in an ER. they would not call my OSS or my PMdr. I had to go pee so bad and since i couldnt move I asked them for a catheter or a bed pan, the nuirse looked at me and said there is no way i am going to give you a catheter. I ended up urinating all over the bed and when she came in she said how disgusting that was, and i could have had the decency to get out of bed and conduct myself like a human being not an animal. I am now stuck in bed and they put me on valium . i have not slept for 3 days and I am in full blown depression and I am just at the end of my rope.

Julaine
__________________
Back pain 16 years Chiropractic care 1993-1994DX 2003 DDD at L4 5 S 1January 04-Nov 04 Epi Injections October 04- March 05 Morphine, vicodin, Duragesic, June 05:Blue cross denied my two level ADR
august2005 woke up and had no feeling in legs was in
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  #9  
Old 07-11-2005, 12:54 AM
Pat&Robin Pat&Robin is offline
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Dear Julaine,
I am a nurse and am horrified to hear how badly you were treated in the ER. You don't need more stress, but maybe it would make you feel better to make a call to the nurse manager and tell her about your awful experience. That ER nurse should be held accountable.
Just ride it out. That's what I tell my husband. It seems this back saga is lots of downs but a few ups, so hang in there, this is a temporary setback. My husband also goes through periods of not sleeping and he feels like he is loosing his mind. Then things will improve for awhile.
Also fighting the insurance nightmare here too.
chin up,
Robin
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  #10  
Old 07-11-2005, 06:52 AM
Rein Rein is offline
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Amen, Robin! I could hardly bring myself to reply again so quickly to Julaine (I was so shocked and horrified), but I'm sure other nurse(s) here would agree. That ER needs some serious quality control review and that nurse needs to have her job threatened! There is absolutely *no* excuse for that kind of behaviour! People come into the ER (a lot of time) in agony and unable to function and anyone working there knows that!

Julaine - Hope you're feeling better today. I know if I were taking Valium *I* certainly would be! ;-)
__________________
03/09/26 - Ruptured L5-S1.

Years of pain, discectomy, research into anatomy, hardware, clinical trials, facilities, surgeons, techniques, insurance. Attempts at ProDisc, Activ-L trials. Now, low bone density. D'oh!!!

At 61 years, no longer qualifying for trials due to my age (chronological, not physical or mental).

2009 - Working on improving bone density or getting rich so I can go to Germany, where medicine and insurance have gone beyond the Stone Age.
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