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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 11-30-2005, 09:45 AM
Judy Judy is offline
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Hi Laura, I would greatly appreciate asnything you can send me on your appeal process. I am currently in the process of appealing Cigna Healthcare for my surgery.

Thank you in advance for your help.

Judy
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Surgery Vienna by Dr. Bertagnoli Oct. 16, 2004
ADR L3/4
Fusion L4/5
ADR L5/S1
Diagnosed with Arachnoiditis 11/06
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  #12  
Old 12-02-2005, 04:55 PM
ans ans is offline
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Laura: You kicked butt in your perserverance. Also, I wish you the best for your surgery. Finally, thank you for helping others obtain approvals as a result of your v. hard work. - Allan
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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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  #13  
Old 09-01-2006, 12:22 PM
dan dan is offline
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Hi. I just receivd a letter of non-certification from my insurance company, Blue Cross. I need a disc replacement at L5. Rick Delamater is slated to perform the surgery (using a ProDisc) on October 5. I would be greatly appreciative if anybody has any thoughts or suggestions as to to the viability of appealing the BC denial.

Alternatively, my wife has Great-West availble to her--does anybody know if they cover this surgery?

Lastly, if Great West doesn't, and my BC appeal is not fruitful, I am starting a new job in January and will be able to choose from many insurance companies--which ones cover this procedure?

Thank you in advance.

dan lowenthal
long beach, ca
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dan lowenthal
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  #14  
Old 09-01-2006, 01:00 PM
David David is offline
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Not that this helps, but, to my knowledge, you are the first person to receive a denial for U.S. Prodisc (that I have heard of)

David
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47 years old
Surgery: 14-NOV-2006; Straubing, Germany (Dr. B.)
L4-S1: Prodisc
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  #15  
Old 09-01-2006, 05:07 PM
dan dan is offline
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You mean companies are approving ProDisc right now? If so, which companies? Rather than enter into a protracted battle with Blue Cross, I'd like to just sign-up with a company that will do the right thing.
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dan lowenthal
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  #16  
Old 09-01-2006, 05:19 PM
David David is offline
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What I mean to say is that Prodisc was FDA approved about two weeks ago, I seriously doubt that any insurance company will cover Prodisc surgery for quite awhile.

(ie, you are the first person to post that has asked for Prodisc coverage. I plan on waiting until mid-October to ask for my Prodisc denial)

Charite was FDA approved in 2004, and many insurance companies continue to deny people for that a particular device.

David
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47 years old
Surgery: 14-NOV-2006; Straubing, Germany (Dr. B.)
L4-S1: Prodisc
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  #17  
Old 09-01-2006, 06:56 PM
jf110 jf110 is offline
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Laura,
Congratulations to you on your approval. I went through three appeals back last year when i finally got my approval for ADR surgery at the Texas Back Institute. My insurance was BCBS also. I am glad you stuck with and won. Mark
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  #18  
Old 09-02-2006, 08:10 AM
Mariaa Mariaa is offline
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Laura,
Have you had surgery yet? If so, how are you doing?
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  #19  
Old 09-02-2006, 08:13 AM
Mariaa Mariaa is offline
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Dan ~ are you in Long Beach? So am I..
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  #20  
Old 09-02-2006, 10:31 AM
dan dan is offline
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Yes, I am in Long Beach--my family lives in the Rose Park area. My local physician in Eric Feldman--he referred me to Delamarter.
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dan lowenthal
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