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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 03-22-2014, 09:21 AM
cruiser cruiser is offline
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Join Date: Jan 2014
Posts: 13
Default BCBS reversed their denial and paid for multi-level cervical ADR!!

Success. After my out of pocket trip to Germany for two new shiny M6-C's I was denied payment by BCBS. I put together a 40 page binder full of clinical studies, white papers, and medical journal articles. I had them professionally printed, and bound. There was a cover letter, as well as a table of contents included.
BCBS reversed their denial and cut me a huge check.
Surgery was September 2013. Denial at the end of December was for "medical tourism" and "experimental procedures". In January I started my research for appeal and sent the reports with request for reimbursement. After many phone calls in the intervening months I was approved at the first level of review and the check came in mid-March 2014. No lawyer, no advocate, just some time on the internet and a little perseverance. I am elated!
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C 3-4-5 fusion circa 1981
2 Spinal Kinetics M6-C's at C 5-6 and C 6-7
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  #2  
Old 03-22-2014, 10:16 AM
FranklySir FranklySir is offline
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Join Date: Jun 2013
Posts: 177
Cool Awesome Cruiser

Well done my friend!!!!
Same here but without the denial. I basically did all that up front. 100% Paid out minus the extra hotel and flights......

Hope your recovery is going well..

Frank
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Lumbar issues 18 yrs
herniations lumbar L3-5 multiple Epis etc etc
Annular tears L3-5 cauda equina
Cervical herniation symptoms 2011
C5-7 M6C by Dr Clavel on June 5 2013
L3-5 M6L by Dr. Clavel on 12.18.13
Living life instead of living the condition
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  #3  
Old 03-30-2014, 10:30 PM
cruiser cruiser is offline
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Join Date: Jan 2014
Posts: 13
Default

So far so good. No surgical pain in the implant sites. However I do have a great deal of pain and strength issues with my right arm, shoulder, and hand due to the stenosis from my C 5-6 and C 6-7 osteophytes and foraminal impingement. 30 years since my first fusion have caused some problems. As a very active person and a Commercial Pilot by trade, this whole pain and inactivity has really got me down.
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C 3-4-5 fusion circa 1981
2 Spinal Kinetics M6-C's at C 5-6 and C 6-7
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  #4  
Old 04-08-2014, 08:44 PM
Jerry5 Jerry5 is offline
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Join Date: May 2013
Posts: 363
Default Info

Thank you to Cruiser and Franklysir, I have submitted the international claim, and I will give this another week and push to get an answer, do not plan on this taking much more time, this is really hard on the body and mind.

Thanks again.
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Jerry, Somewhere Ohio

L2-3 herniation, two days before Thanksgiving, 2012, Discectomy/Laminectomy, 3/13 Numbness in the right leg, lateral femoral, gone, July 10, 2014 L45 M6 ADR, July 15 PLIF L5-S1, Not able to access L51 Anterior.
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