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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 05-22-2007, 09:42 AM
Julaine Julaine is offline
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I see DR. Kropf at the spine institute and they are wantng to do a ADR and then remove hardware from a fusion. Blue cross says they will pay for the surgery butnot the disc or the vascular surgeon. Anyone else have this problem?
thanks
Julaine
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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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Old 05-22-2007, 11:38 AM
CHILLEE CHILLEE is offline
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Harrison just put up a great thread from an awesome lady on how to fight your ins. co. and appeal the big "NO". I would start with obtaining a copy of that book, it seems to fit alot of our situations on this board. Cheers!
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08/99 Herniation L5-S1
03/02-12/02-PT and 3 epidurals
01/04-11/04-PT, Chiro, 3 epidurals
03/30/05 ADR Charite at CINN, Dr. Noam Stadlan
04/24/05 Return to CINN inpatient for pain control issues
01/18/06 Hospitalized for pain spike, 5 day stay
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Old 05-22-2007, 05:58 PM
ZorroSF ZorroSF is offline
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I know blue cross is covering ADR in San Francisco at St Mary's, but it could be another story in another state. A revision surgery also adds another twist to coverage. I'm not so sure revision surgery is as common as a first-time ADR surgery.

Even St Marys had a heck of a time trying to get blue cross onboard, but they were covering it by end of last year. At the same time St Mary's is also one of the original trial centers for ProDisc, so I'm sure that was also a factor.

BTW I couldn't imagine being 32 days in the hospital. I was going nuts after 6.
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1/2006 DDD L5/S1

Prodisc St. Mary's 12/2006 not diagnosed properly pre-op and now have DDD L4/L5, facet calcification L5-S1/L4-L5, mild scoliosis and left knee pain. DDD: C3 through C6
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Old 05-26-2007, 11:23 PM
ZorroSF ZorroSF is offline
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well I am mistaken. I just received the bill from St Mary's stating that Blue Shield will not cover the disc or the surgeon's bill, but they paid most of the hospital bill.

This is whacked. I was told by my hospital that blue shied of California approved the procedure.
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***********************
1/2006 DDD L5/S1

Prodisc St. Mary's 12/2006 not diagnosed properly pre-op and now have DDD L4/L5, facet calcification L5-S1/L4-L5, mild scoliosis and left knee pain. DDD: C3 through C6
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