United Healthcare Rejection

[colorado2718]

Hi RP,

Thanks for all of the information and good luck with your efforts!

I'm just now starting the process and haven't even tried submitting anything to UHC, but based on my research I think it's certain that I'll be rejected unless I accept fusion as a treatment.

My back has gotten significantly worse over the last month so I've started moving from just doing research to scheduling appointments, etc. I expect to start having to deal with UHC very soon (one I get a recommendation from the doctor).

I'd appreciate any recommendations or information that you may have to help with this process.

[gymnast1981]

Originally Posted by Jdouglas

They were obviously far more concerned with pointing out that he wasn't in the room the first time they rejected ADR then recognizing that he is a PLASTIC SURGEON. It's almost funny. Almost. And to think all this time I should have been seeing a Plastic Surgeon for my back problems.

I would have to say that UHC did the same thing with me. I had the first denial upheld and now we are going forward with the second appeal (independent reviewer orginization) and are more hopeful with this one. But the "DOCTOR" that did the review of my case was a doctor that graduated from medical school in 1961, and he's a pediatrician.

Next time you try to get a health insurance company to cover any kind of modern medicine, be prepared for them to consult the oldest living doctor in the world.

I mean seriously I know I'm only 30 and maybe look like I'm 24 but come one a pediatrician????????

anyone else have UHC give them a doctor that has NOTHING to do with their case?

[prusinski]

Just wanted to update anyone interested in the ProDiscL study which started back in 2006 and should be concluding shortly.

PRODISC®-L Total Disc Replacement - P050010

Links on this FDA page show labeling has been accomplished and further data should be forthcoming this year. I've applied for an Axiomed FLD study and was denied, however, that study used ALIF fusion as the baseline verse Synthes ProdiscL, so it was risky if one didn't want fusion. I didn't feel a great loss to that. Many studies, still open, use ALIF fusion against either the ProdiscL or FLD: Please read the FDA study details before considering any of these procedures.

Currently, Axiomed has several ADR study locations where the candidate gets either; the Axiomed FLD or/v. ProdiscL. Note that in these studies the ProDiscL is now the baseline - not fusion - as used prior, circa 2006.

My neurosurgeon from Rush University Hospital in Chicago says that the ADR proceedures are about 10% better than ALIF fusions from his interpretation of early data and personal surgical experience. So, after six (6) years we're looking at 60 - 80% satisfaction rates, which are higher than the 50 - 70% with ALIF fusion. I've been in multiple Workman's Compensation Hearings in Illinois over this fight for ADR. My WC carrier is Travelers, but my private carrier is UHC up in Wisconsin where I live. The hospital prefers using WC payments because they pay a greater percentage than the typical 50% or less of today's private criminal carriers, i.e. UHC. Should I not get approved in ILWC (Travelers) hearings or continued attempted appeals with UHC, I shall work harder to enter one of these ongoing studies with disc verses disc.

BTW, I'm also challenging UHC for specific medication coverage denials; which they covered last year but have started denying this year: All things being equal except on their end. Seems, I'm spending more time in hearings or collecting data in prep for hearings for numerous items these days. I just hope there are still a few humans to act as judge - not just the usual pro-corporate owned actors many of us have seen.

Anybody from New Zealand in this forum? I'm wondering how progressive Countries deal with medicine?

[gymnast1981]

I have UHC and have been fighting with them since April 2011 and as of October 31, 2011 an independent review company (MCMC LLC) reviewed my claim to approve ADR and my request has been approved!

So it is possible to fight UHC and WIN!!!

[Texas Toast]

Hey, congratulations gymnast1981! It's so great to hear success stories; especially with insurance companies. The struggle you went through will make it easier for those who try later. Thanks!

[JEVE19]

Congratulations! and can we get an Amen!

[JEVE19]

Congratulations!!
and can we get an Amen!

[Texas Toast]

Aaammmeeennn!!!

[gymnast1981]

Ok so I said that my surgery for ADR is Nov 29... Doctors office called to reschedule it... now its November 22. Im kind of freaking now!!! nervous and yet excited!

[christinlal]

and Congrats on getting the approval from UHC!