ADR-Friendly Insurance Companies

[tkdodger]

Originally Posted by Harrison

The following insurance carriers have issued a positive coverage decision on the Prestige Cervical Artificial Disc:

BCBS Illinois

Source: 1-800-446-1234 or visit www.cinn.org. Original article here.

I have received notification from BCBSIL that ADR is still considered experimental, since no long term data is available to prove that is is BETTER than fusion. BCBSIL will NOT cover any costs associated with ADR procedure.

[brianw48]

Does anyone have copies of Approval letters from Anthm/BCBS of California, for Cervical ADR?

I would very much like to have some names and examples of approvals for my appeal.

If you have an Appeal letter that worked with Anthm/BCBS of Californis, I would be interested in that as well.

Feel free to email to: brianw6212@gmail.com

[semathes]

I would like to join forces with anyone who has experience with Anthem BCBS or any other BCBS for that matter.

I'm in need of any successful coverages, appeals, court cases, etc. for lumbar ADR.

[Cheryl0331]

I have heard that some will pay 50% of what Medicare will cover, but what about next to a prior fusion? Has anyone here heard of an insurance company at least covering the Discectomy portion. They would still have to pay for that part of it with a fusion. Just reimburse the surgery cost and let us pay out-of-pocket for the ADR device.

[Jerry5]

But I would talk to your doctor about a Two Level Mobi-C, maybe you can have one of the Fusions removed, or above or below, or above and below, the mobi-c is approved for two levels.

The insurance is real funny, they will fight like the dickens, and say it is NOT approved, then go back at them, AFTER you have it done, and they will reimburse.
Risky, but it does work, in some cases.

First, Talk to your doctor about the Mobi-C, have them submit the paperwork to the insurance.

[brandis77]

Just wanted to post that BCBS TX approved my 2 level cervical ADR with the Mobi-C, and it took them less than a week to approve.

[Cheryl0331]

mobi-c will be great for two level but if the disc above/below are even iffy, I would want the m6; that said, insur wil pay for two level mobi-c so I'd go for it! I can't do it though with a prior fusion. Blumenthal's Pat. Coord said I was not a candidate.

[Cheryl0331]

Originally Posted by Jerry5

But I would talk to your doctor about a Two Level Mobi-C, maybe you can have one of the Fusions removed, or above or below, or above and below, the mobi-c is approved for two levels.

The insurance is real funny, they will fight like the dickens, and say it is NOT approved, then go back at them, AFTER you have it done, and they will reimburse.
Risky, but it does work, in some cases.

First, Talk to your doctor about the Mobi-C, have them submit the paperwork to the insurance.

Then I read about Dr. Katzman in FL. and Dr. Kenneth Light in CA. so are they for real? I think if I got the M6 at C 6/7/T1 then had the PEEK cage removed at C 3/4, I might have my life back.

[Cheryl0331]

Or just go have it done anyway and beg later??? That way they can't say, "we told you and you did it anyway, now you want us to pay"

[Jerry5]

Cheryl,
Go ahead and send the MRI/xrays to Bierstedt, (there are others) (the USA does not allow the M6 to be implanted, yet) and get the recommendation from them, submit this to your insurance.

If they deny, they most likely will, then if you can afford it, take it out of a 401 or some other savings, pay for it, then send the Bill to the insurance, for reimbursement.

Most likely they will deny this, but use all your apples, tests, doctor visits, medications, trouble at work, trouble in life, list all, list all the problems, then APPEAL, and APPEAL again.

All the best, and best of luck, the M6 is the best choice, unless you can have the mobi c placed at the lowest level that is giving you trouble(C7T1), then fuse further up, from what other people that have cervical have told me,
Maybe do a hybrid, one level mobi-c, then fusion, or cage, then another level mobi-c then another fusion, this would be 4 levels?