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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
02-05-2007, 08:06 AM
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In reviewing the fee updates for Az BC/BS, I noticed that lumbar ADR is listed with a procedure code. So, at least for some contracts, Arizona Blue Cross/Blue Shield is covering this.
Hope this info helps in the insurance fight.
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2001 MVA; C5-C6 disk extruded ongoing physical therapy, exercise and massage ESI's, oral prednisone, trigger point injections foraminal and central stenosis C5/C6 and c6/C7 2007 EMG/nerve conduction shows pattern of chronic radiculopathy January, 2008: Prestige ST Artificial Disk Replacement, C5/6 
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#2
02-05-2007, 09:56 AM
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That's interesting and wonderful news! Thanks for sharing this (surprising) news.
On the flip side of this is the actual reimbursement amount provided to doctors' offices. I've heard from doctor's office managers that the reimbursement for the ADR procedure is $1400, vs. almost $10,000 for fusion. If this is true, then there could be (or there already is) all kinds of consequences for the patient community. 
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"Harrison" - info (at) adrsupport.org Fell on my ***winter 2003, Canceled fusion April 6 2004 Reborn June 25th, 2004, L5-S1 ADR Charite in Boston Founder & moderator of ADRSupport - 2004 Founder Arthroplasty Patient Foundation a 501(c)(3) - 2006 Creator & producer, Why Am I Still Sick? - 2012 Donate www.arthropatient.org/about/donate
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#3
02-10-2007, 01:55 PM
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so your stating teh reason doctor haven't jumped on the ADR bandwagon is cause they aren't getting paid their fair share?
This would help explain why ADR has just begun to hit US shores
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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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#4
02-10-2007, 04:54 PM
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Zorro, I don't know what the implications might be for the reimbursement; I think the whole situation is complicated. My hope is that the difference in reimbursements (ADR vs. fusion) will not bias the decision(s) of all parties involved -- but I think that's idealistic!
If anyone else insights or comments, please share them. 
__________________
"Harrison" - info (at) adrsupport.org Fell on my ***winter 2003, Canceled fusion April 6 2004 Reborn June 25th, 2004, L5-S1 ADR Charite in Boston Founder & moderator of ADRSupport - 2004 Founder Arthroplasty Patient Foundation a 501(c)(3) - 2006 Creator & producer, Why Am I Still Sick? - 2012 Donate www.arthropatient.org/about/donate
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#5
02-10-2007, 05:12 PM
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I have serious doubts that there is such a great disparity in fees for the 2 procedures. Procedure codes allow billing for arthroplasty/arthrodesis, with additional billing for instrumentation; there are probably other procedures involved in the surgery that are billed separately. Fusion may involve bone harvesting and grafting and perhaps may therefore have a higher total fee. I don't know the specifics but I do know that the fees listed for arthrodesis for BC/BS are not $10,000--but the total for all procedures involved in the surgery may approach that. Again, I doubt that the total fees for all procedures involved in ADR are that much less.
__________________
2001 MVA; C5-C6 disk extruded ongoing physical therapy, exercise and massage ESI's, oral prednisone, trigger point injections foraminal and central stenosis C5/C6 and c6/C7 2007 EMG/nerve conduction shows pattern of chronic radiculopathy January, 2008: Prestige ST Artificial Disk Replacement, C5/6
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