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| The Big File All issues not easily categorized in the above forums are here. Comments on general health, diet, "getting comfortable," and more are here. |
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#91
06-16-2005, 07:33 PM
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FWIW...
My doc has told me that UHC has been the worst when it comes to approving ADR. I have MAMSI, which is owned by UHC, and I don't believe they even looked at my appeal before they denied it. What *really* gets me is that my appeal (as I've stated as couple of times in the forum) was based solely on the regulation that prevents Federal Employee insurers from labeling an FDA-approved product as experimental. In my denial letter, they never addressed the regulation - never even mentioned it. Basically, they completely blew me off. -stan
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Stan L5-S1 DDD and herniation 
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#92
06-17-2005, 08:21 AM
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New news from my doctor's office yesterday concerning my first appeal:
BCBS has notified my doc's office that they have received and reviewed my appeal information submitted solely from my doctor's office. They advised us to "hold out" till July 1, 2005 and resubmit my claim (precert) to them. The AMA has new codes for the ADR procedure that will take affect then. Right now, the codes submitted are not specific to this process. Well, BCBS is not saying that they will give me the go ahead with the new codes-- but it is the most (almost) positive thing I have heard from them to date. I know there has been a lot of talk about coding in this forum. I have followed it all. I also realize that bcbs may just be wasting some more of my time. Only time will tell. I have been checking into other ways to get this done and will not hold my breath for bcbs to come through. I will post again after I hear something after 7-1-05. I have only been waiting since the end of February!!!!!!!
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L5/S1 Ruptured DDD
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#93
06-17-2005, 01:04 PM
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Interesting news Walker, thanks. I have my discogram and some kind of reversal test on the 28th and then my doctor will be submitting the pre-cert. Is it possible for once that my timing might be good?
I will not get too excited, but that is something good to hear!
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Juli DDD L3-L4 on down since 1990 Surgery 9/26/05 with Dr. Bitan in NYC to complete partial congenital fusion of L5-S1 and ADR at L3-L4 and L4-5. Feeling great!
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