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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 09-24-2007, 08:49 PM
rayray_1 rayray_1 is offline
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they have totally denied my two level pro disc with delamarter, cash price is $65,000 if everything is perfect with only two day hospital recovery time!!BX will not even pay for any of my hospital stay!

I'm considering going overseas to get prodisc, any suggestions or dr.s to refer me to would be appriciated.
thanks
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auto accident 2 years ago
herneated disc L4-L5
herneated disc L5-S1
anular tear L5-S1
DDD L5-S1
4 medrol dose packs
3 epidurals
darvocet, vicoden and tylenol4

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  #2  
Old 09-25-2007, 06:01 AM
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Quote:
Originally posted by rayray_1:
they have totally denied my two level pro disc with delamarter, cash price is $65,000 BX will not even pay for any of my hospital stay!
Rayray_1

Sorry to hear about your insurance. Mine was $70,000 for two level disc. I know it is hard to try and figure out how to do it all.

I opted not to go over seas but I am sure there are many on here who can help you.

All the best
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  #3  
Old 09-25-2007, 12:10 PM
Don Don is offline
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There aren't many folks I'd wish back problems on, but CEO's of insurance companies might make the list....
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Don G.

3 level DDD L5-S1 through L3-L4.
"Compressed" L5-S1 in ~1992.
Herniation at L3-L4 and L4-L5
Fusion or ADR in near future
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  #4  
Old 09-25-2007, 12:14 PM
Don Don is offline
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I have been wondering if the insurance companies would pay for 1 level of fusion if I pay for the levels of ADR. I had something like that done years ago. They paid for half of everything for a neede surgery, and while I was out, I had my vasectomy reversed. Cost me about $1900, (a lot when I was making $4 an hour) but I have a lovely 10 year old daughter who is worth every penny and more. I doubt if they'd go for it now.

Good luck to you RayRay1. What state do you live in?
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Don G.

3 level DDD L5-S1 through L3-L4.
"Compressed" L5-S1 in ~1992.
Herniation at L3-L4 and L4-L5
Fusion or ADR in near future
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  #5  
Old 09-28-2007, 09:47 AM
Tom Panchaud Tom Panchaud is offline
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I have been researching the Alpha Klinik in Munich, Germany - cost is around $35K plus travel expenses for a 2-level ADR, which is what I am considering. Drs. Zeegers seems very attentive to detail and is working with me to make sure the diagnosis is correct for the treatment I am expecting. Very thoroug. Check them out on-line (www.alphaklinik.com)
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Cheers, Tom
L4/L5 L5/S1 Laminectomy 1998, possible L4/L5 L5/S1 tried physiotherapy, prolotherapy, epidurals, nerve root blocks, facet blocks, acupuncture, chiropractics, and deep-tissue massage, currently trying nerve root ablation.
At the end of m
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  #6  
Old 09-29-2007, 04:18 AM
Julaine Julaine is offline
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i feel you.. dr delamarter and Kropf as well as my PM Dr davis put in a request for disc replacement surgery and as well as take out the hardward from prior fusion that is causing me excrutiating pain. Blue cross denied the removalof the hardware andmanaged care upheld the decision, then get this
dr davis put in a request for me to go through detox and they denied that as well, so it goes to show that they are being run by the pharmaceutical companies. why else would they continue to pay for my morphine percocet fentanyl cymbalta, and zanaflex. they would rather pay for me to be addicted and dependant than go to detox.
somehting needs to be done we need to take a stand
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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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  #7  
Old 09-29-2007, 08:54 AM
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Terry Terry is offline
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Julaine:

I sent you a private message to offer some assistance.

Terry Newton
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1980 ruptured L4-L5
1988 ruptured SI-L5
1990 ruptured C5-C6
1994 ruptured C6-C7
1995 Hemi-Laminectomy C5-C6, C6-C7 Mayo Clinic
Bicycle Accident 2004
MRI, EMG, Facet Injections, Epidural Blocks, Lumbar Discogram.
Stenum Hospital Surgery November 4, 2006
Prestige Disc C5-C6, C6-C7
Maverick Disc S1-L5, L4-L5
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  #8  
Old 10-01-2007, 07:00 AM
QueenB2411 QueenB2411 is offline
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I am in the exact same situation. Blue Cross has denied my 2 level ADR as well. There are some insurance companies that will cover it though so right now I am doing my research to see about getting an individual policy with Aetna or CDPHP. Aetna coverage would cost me about $900/mo, which is a lot but in most situations cheaper than any other option.
It might be another option to research for you.

FYI I too would probably stick insurance CEOs on a back problem list as well, just so they can see how enjoyable it is.
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~ Hollyn
30yo mother of 3
L4-L5 DDD
L5-S1 DDD and herniation
Physical Therapy for 2 yrs, 2 epidural injections, 1 facet injection, discogram on 9/20/07 confirms 2 level ADR needed.
I wear a back brace and use a NMES/TENS unit in addition to taki
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  #9  
Old 10-02-2007, 07:38 PM
rayray_1 rayray_1 is offline
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thanks you all so much for your responses. it get's lonely being in this f****d up situation, and it helps to hear from people who can really relate. queenb, won't aetna deny you baised on a previously existing condition? tom, thanks for the overseas contact i'll use it asap. and i'll keep you posted.
thanks ray

ps and those c.e.o.s deserve to have a spinefull of herniations and ruptures!!
__________________
auto accident 2 years ago
herneated disc L4-L5
herneated disc L5-S1
anular tear L5-S1
DDD L5-S1
4 medrol dose packs
3 epidurals
darvocet, vicoden and tylenol4

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  #10  
Old 10-06-2007, 10:37 AM
Lisibug Lisibug is offline
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I checked into having Delamarter do my 3 level ADR, but the hospital costs alone were more than having the surgery done by who appeared to me to be the best ADR doc in the world - Bertagnoli, in Germany. The cost for a 3 level ADR, plus taking plate and screws out from prior fusion, was just under $47k. I think it's nearly $10k less per level required. I was extremely impressed with the care I received there - much more attentive than the U.S. hospitals and I'm happy with the results of my surgery. My insurance company wouldn't pay for anything, either. Sure hope that wherever you decide to have surgery, that you feel much, much better afterwards. By the way, if you go to GY, to your great surprise, you will be well enough afterwards to do a little sightseeing. Make sure you see Neuschwanstein, the castle the Disneyland castle was modeled after (it's located in the Alps - fantastic views everywhere). I lived in the UK for 9 years and have seen a lot of castles but this one is my favorite. Fussen, the town just before ascending to see Neuschwanstein, is gorgeous and we want to go back there with our kids and stay. Also, see the Marienplatz in Munich. There is a lovely outdoor market somewhere around there too, that is just so delightful with unusual and beautiful things for sale. Straubing is a lovely town you may stay in which is where one of his surgery locations is located and near another one. Bogen, near Straubing and where I had my surgery performed, is also a delightful little town. I couldn't believe I was able to do light sightseeing - but I could. To see the castle, I laid against my husband or the interior side of the bus to rest my neck while we were traveling. I was so surprised to be able to use this opportunity not only to get better, but also to have a great time!
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Lisa
Back/neck pain with chiropractic treatment 3 x week in 1973 (age 13) for 1 year and pain since then due to falling off horses
headaches since age 17
Onset of severe fibromyalgia in 6/95, undiagnosed for 2 years while lived in UK
About 1998 o
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