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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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  #11  
Old 02-17-2007, 07:40 AM
chasswen chasswen is offline
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Join Date: Apr 2006
Posts: 627
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So LBP
have we found a lawyer yet For the class action law suit?
i think it's time to teach those idiots a lesson.
no?
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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  #12  
Old 02-17-2007, 09:07 AM
davidj8121 davidj8121 is offline
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Join Date: Sep 2006
Posts: 181
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Chuck,

You know I'm in. Denied by Highmark Blue Cross/Shield for single level Charite/Prodisc.
Went to TBI for surgery on 2/8/07. I live in Pittsburgh, PA. Still in the appeals process but I do not expect anything.

If you don't mind Chuck I will make an inquiry with my attorney this week. Have some other business to discuss and he may have some good info for me. He works for a pretty big law firm. I will be glad to pass the info on to you.

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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  #13  
Old 02-17-2007, 09:09 AM
chasswen chasswen is offline
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Join Date: Apr 2006
Posts: 627
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david
that sounds like a plan.
it surely would not hurt to try to find someone.
and if i cant slam them in the lower back with a 2 by 4 then we must become there worst nightmare.
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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  #14  
Old 02-17-2007, 09:15 AM
chasswen chasswen is offline
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Join Date: Apr 2006
Posts: 627
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if insurance company must pay for gov employees if fda approved what gives them the right to change for the private insured i want to see them tell a fed judge that the fda branch of gov is useless.
chuck
p/s its a double standard that must go if its not fda approved then they say no it's not approved.
and if its fda approved and they dont want to pay it becomes experimental. GRRRRR
__________________
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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  #15  
Old 02-20-2007, 03:24 AM
Kim_Dean\'sWife Kim_Dean\'sWife is offline
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Join Date: Oct 2006
Posts: 108
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HEALTHNET may soon pay for Prodisc adr! We were denied by HealthNet today for my husband's two level ADR; however, when HealthNet contacted Dr. Yue's office to inform them of the denial, HealthNet said that they are considering changing their position on covering these procedures, and said to tell us to appeal! Dr. Yue's office has never been told anything like that from any other insurance company! I'll keep you all posted if I hear anything else.
-Kim
__________________
Wife of Dean, age 32.
Injured 12/05- snow shoveling.
Herniated Discs & DDD at
L4/5 & L5/S1.
-Chiropractic treatment
-3 Failed injections
-Orthopedic Massage
Prodisc Surgery on 2/22/07 Dr. Yue
Yale New Haven Hospital, CT
L4/L5 & L5/S1
Back
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  #16  
Old 10-30-2007, 10:12 AM
nice nice is offline
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Join Date: Oct 2007
Posts: 9
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Where are you on your list I want to join!!
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  #17  
Old 10-30-2007, 10:47 AM
LBP LBP is offline
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Join Date: Aug 2005
Posts: 446
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posting on this thread with relevant info makes a list
__________________
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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  #18  
Old 10-30-2007, 11:29 AM
LBP LBP is offline
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Join Date: Aug 2005
Posts: 446
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Quote:
Originally posted by LBP:
I would like to start a list of people who still have been denied ADR surgery by their insurance company.

What city do you reside, how many levels do you need, and who is your insurance company that denied you. Please specify if you are a workers compensation case because that is a whole different animal.

I am curious to know how many people with single levels still aren't being approved or are they only ones with trouble the ones with multiple levels?????



Anyone interested in posting your information?

Maybe it would be good to also include those that have paid out of pocket to go to Germany because they were denied by their insurance company.
__________________
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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  #19  
Old 10-30-2007, 12:04 PM
Ray R Ray R is offline
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Join Date: Dec 2006
Posts: 26
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Denied by BCBS of Alabama. Went to Germany paid out of pocket for 3-level cervical. Still appealing. Sign me up for the lawsuit.Not workers comp.
__________________
Cervical ADR C5-T1 with Dr. Rudolph Bertagnoli. Bogen, Germany 3/09/07.
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  #20  
Old 10-30-2007, 12:08 PM
nice nice is offline
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Join Date: Oct 2007
Posts: 9
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I have been denied by
Health Link and Mercy Medical Group.
I have only one disc L4 L5.
It is not workmans comp.
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