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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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  #1  
Old 12-02-2006, 09:41 AM
chasswen chasswen is offline
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does anyone know how many people are needed for a class action law suit?
and secondly how many people here want to sue Blue Crap?
i am in the process of submitting bills from Adr in Germany. sending the bills to IBX indepenant blue cross and another copy to Blue shield worldwide.
the law suit would be about there double standard between fed employees and privitey insured.
chuck
p/s i xpect IBX to turn down request for payment i surely hope i am wrong that would reflex there true colors.
__________________
ddd 1990
2003 mri,xrays,shots,emg
2004 discogram ouch pos l4 l5
facet block neg
lost all appeals BCBS 5 months of that
3 surgeons later
surgery with dr. bertagnoli aug 2nd 2006 in Bogen Germany Successfully ProDisc-L L-4 L-5
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  #2  
Old 12-02-2006, 11:20 AM
Nairek Nairek is offline
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Hi Chasswen,

I’m not sure how many people are needed to file a class action lawsuit. It may vary on a state by state basis. I’ll try to find out the answer for you though.

I received notification from Empire BC/BS the other day that they have denied my 1st level appeal to have the Charite ADR surgery. I am gearing up to fight them with my 2nd level appeal as I only have 45 days to get that in. Happy Holidays huh?

My OS wishes that an attorney would come forward & file a class action lawsuit on the behalf of those denied by their insurance companies. The problem, there really isn’t any money to be made by the attorney if all they are fighting for is to allow people to have the ADR surgery & have their insurance pay for it. Also, who pays the attorney’s fees? It would be great if DePuy Spine & the other manufacturers of artificial discs would assist us in fighting the insurance companies and have them foot the attorney's bill.

I hope that everything works out for you & that you receive reimbursement for your surgery. Please keep us posted on this as well as your recovery!
__________________
----Karin----
Disc Bulge C4/C5, Disc Degeneration T11/T12, Bi-Lateral tears L5/S1, Diagnosed w/ Lumbar Disc Derangement w/ Radiculopaphy. Treatment: IDET, Percutaneous Discectomy, SI Joint Injection, Facet Block. All failed. Empire BC/BS Denied Coverage for ADR-lost all of my appeals. MVP also denied coverage.

ALIF/PLIF Fusion 1/20/09
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  #3  
Old 12-02-2006, 12:06 PM
chasswen chasswen is offline
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well it seems that if you work for the gov. and insured by the feds they must pay for any thing fda approved. but once you be come privately insured that changes its not right.
karin i think they would approve the prodisc before they would approve the charite. they hate the idea the center can come out if not installed correctly and the study compareion with prodisc is more apples to apples.
chuck
ps you may want to try for approval using prodisc
__________________
ddd 1990
2003 mri,xrays,shots,emg
2004 discogram ouch pos l4 l5
facet block neg
lost all appeals BCBS 5 months of that
3 surgeons later
surgery with dr. bertagnoli aug 2nd 2006 in Bogen Germany Successfully ProDisc-L L-4 L-5
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  #4  
Old 01-17-2007, 09:12 AM
davidj8121 davidj8121 is offline
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Posts: 181
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Chuck,

I think this is an older post but the Class Action Lawwsuit against BCBS I would think could be feasible. Is there any level of interest from others? Even if we all got half the money back and gave half to the attorney it would be better than zero. There has got to be hundreds, if not 1,000's of BCBS people that could be interested. At $20,000 per for an attorney it could be very interesting for someone I would think.

Unfortunately this may be what it takes to wake them up to the fact that ADR is not going away.

(Clarification: if we could all get reimbursed in full from BCBS as a result of the lawsuit we would then in turn give some percentage to the attorney.)

Dave
__________________
David R. Johnson
1996 Disckectomy at L5/S1
12 Months of researching ADR
Surgery 2/8/07 at TBI Prodisc L5/S1 with Dr. Zigler
Feeling Fantastic !!
2009 L3/L4 Finally Went.
6/2009 l3/l4 clean-up surgery, failed miserably
Surgery with Dr. Z again 1/28/2010, L3/4 and L4/5.
That will make 3 Prodisc's. Lumbar feels FANTASTIC!!!!
5/5/10, failed fromanotimy on c5/6.
6/9/10 C5/6 Prodisc replace with the man, Dr. Zigler.
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  #5  
Old 01-17-2007, 09:37 AM
chasswen chasswen is offline
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hello David
congrats on your up coming surgery i will be sending you positive thoughts.
yes there are some others interested. i am in process of waiting on bluecard worldwide reply for request of payment for my surgery they have asked for a itemized list of cost from my surgery with dr. bertagnoli. so if i am denied i will be tracking down a lawyer to sue those pricks and will be looking into a class action suit. i will keep all posted on the out come.
again best wishes for your up coming surgery.
May The Force Be With You!!
chuck
__________________
ddd 1990
2003 mri,xrays,shots,emg
2004 discogram ouch pos l4 l5
facet block neg
lost all appeals BCBS 5 months of that
3 surgeons later
surgery with dr. bertagnoli aug 2nd 2006 in Bogen Germany Successfully ProDisc-L L-4 L-5
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  #6  
Old 02-15-2007, 10:16 AM
Abbe Abbe is offline
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Join Date: Feb 2007
Posts: 61
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Yikes! I guess I could be in for a battle! I only have 16 months left on Cobra with Blue Cross Blue Shield. I was hoping for a fairly quick resolution. I am waiting for Dr. Lytton Williams's letter and I have a packet I have been putting together with research to send to Blue Cross Blue Shield. Has anyone been approved by them for Disc Replacement? I am in California. Any suggetions? I am open....

Thanks,
Abbe
__________________
Water ski accident 86'
Chiropractic& PT Pain meds
Discectomy Laminectomy
L5 S1 Partially sacralized
97' epidural injections
L3 L4 ruptured and torn
L4 L5 Almost no disk height left along with osteophytes
Left leg pain and tingling going down back of leg into heel & foot
3 appeals with BCBS no success Lost insurance.
Kaiser Permanente
L3-L4, L4-L5 Prodisc 9/18/09
C5-6 & C6-7 ruptured and looking at hybrid surgery fusion & Prestige ADR
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  #7  
Old 02-15-2007, 10:56 AM
LBP LBP is offline
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Posts: 446
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abbe,

I would seriously consider looking into whether you can get Aetna. I cant take out an invidual policy for Aetna in my state but they do offer that option in some states. Might be worth investigating. I haven't heard of anyone yet declined by Aetna. Officially their policy says they only cover 1 level but they have covered 2 levels. not sure about 3 but they are your best choice. I thought Kaiser was also covering ADR. The downfall with Kaiser is that you are limited to their drs and I'm not sure any of them have that much experience since I've never heard of a Kasier dr involved in any of the trials.


Otherwise...you really should consider Germany being a 3 level

I am very very curious how you got started with Dr. Delamarater's office to try and get FDA approval for an exception to the ProDisc 2 level trials...even if you didn't get any follow through...how did it get started? I'd like to see if there is a way to get a 2 level exception to the new ActivL single level trials.
__________________
Injured 9/01
Annular tears L4/5 & L5/S1
denied adr by insurance for 2 level charite as well as hybrid fusion at L5/S1 with Charite at L4/5.

New ins paid for 2 level lumbar prodisc surgery on 4/7/08 (at age 39) with Dr. Westerlund, at Core Orthop
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  #8  
Old 07-01-2008, 10:07 PM
katiejane katiejane is offline
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Join Date: Jul 2008
Posts: 3
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Quote:
p
Chasswen,
I have BCBS Federal Employees insurance. Are you telling me that if a device, the Prestige artificial disc, is FDA approved, however, still considered investigatioal, they cannot deny me the surgery? I heard there was such a federal mandate and passed it along to my doctor to help fight BCBS. I need two disc replaced in my neck, so we asked for a fusion and a Prestige and were told no, only fusion. I have been excepted into the Wallis Clinical Trial Study for a disc needing replacement in my lower back, so at least no insurance hassles there.
---KatieJane---
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  #9  
Old 07-03-2008, 01:13 PM
Diane Diane is offline
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Join Date: Oct 2007
Posts: 4
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Katie--

Google "FEHB FDA"--you are looking fro a pdf that indicates that all providers of federal employee health benefit plans need to adhere to the FDA approvals and cover the procedures. Now, the only approved use is single level, not sure about adjoining fusions or not, but that's how I would fight. if you cannot find the letter, email me at djerdee@merr.com and I will get you a copy.
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  #10  
Old 02-13-2010, 01:16 PM
Berylcooks Berylcooks is offline
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Join Date: Aug 2009
Posts: 4
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we are suing Blue Cross. Just saw your message. Let us know if you want to join is.
Berylcooks@aol.com
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