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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 05-21-2008, 11:36 AM
April April is offline
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Unicare has denied approval for the use of an ADR for my husband (who has suffered increasingly debilitating back pain for the past 5 years), claiming that it is "experimental" and "medically unnecessary." We are in the process of gathering materials for an appeal. If you have any experience with appealing to Unicare, we would appreciate any advice. Thanks!
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Old 05-22-2008, 12:31 PM
mmarsh mmarsh is offline
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April

My best advice is to buy Laurie Todd's book. The insurance warrior is what she calls herself. You can only find it on-line. There's a thread about her here somewhere. She has wonderful ideas and will send you a successful appeal for ADR. Best of luck to you.

Missy
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fusion L4-5, Dynesys rods L3-4, fusion c5-6 and C6-7, current problem C-7/T-1
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Old 05-22-2008, 07:49 PM
LBP LBP is offline
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my advice,

If you can get on Aetna, that is the best most direct route. Look to see if one of your employer's offers it, or if you can puchase an individual plan in your state, or switch jobs to get that insurance. After years of fighting/appealing my old ins, I had to wait to win my SS disability appeal to get an Aetna plan. I was injured in 2001, and I just got my 2 level prodisc ADR last month.

Best of luck
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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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  #4  
Old 05-23-2008, 09:00 PM
April April is offline
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Thanks very much to both of you for the advice. I did order Laurie Todd's book,and we plan to put through an appeal for now. (Unfortunately, Aetna is not currently an option.)

April
Husband needs hybrid (one ADR and one fusion)
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