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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 11-16-2006, 04:21 PM
ZorroSF ZorroSF is offline
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I haven't had the best luck with Blue Shield in the past, but within 5 minutes they authorized my request for a ProDisc replacement at L5/S1.

Anyone else have Blue Shield?
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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 11-16-2006, 05:15 PM
Justin Justin is offline
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Great news Zorro! How was your request submitted?

Justin
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Old 11-16-2006, 06:28 PM
ZorroSF ZorroSF is offline
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I really don't know. I just spoke with Dr. Zucherman's assistant and she said there is a new code they use for disc replacements (one that covers both discs). She wasn't surprised at all, but I was taken back.

She said that Blue-cross is pickier than blue-shield and even they authorize disc replacements now.

Something must have just advanced in the insurance industry cause I've read nothing but agony from people here trying to get their insurance to pay for disc replacements.
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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 11-16-2006, 07:23 PM
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Eddie_G Eddie_G is offline
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It's a great feeling 'aint it? They are finally coming around. Congratulations!
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12/16/03 Work Accident
Herniation and DDD at L4-L5
4/1/05 Discectomy
Epidurals and facet injections
5/15/06 Discogram confirmed L4-L5 DDD also an asymptomatic L5-S1 tear
10/24/06 L4-L5 Prodisc surgery with Dr. Goldstein
CAT scans & X-Rays show ossification
Trigger Point Injections, Medial Branch Blocks, Acupuncture, Weekly Deep Tissue Massage
10/27/08 Discogram (positive L5-S1 tear)
11/25/08 L5-S1 fusion with Dr. Goldstein
FAILED BACK SYNDROME
Liberty Mutual WC
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  #5  
Old 11-17-2006, 06:32 AM
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Harrison Harrison is offline
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Well, I am surprised to hear this. But don't forget:

- some requests can be specific to the individual;
- each BCBS operated as legally autonomous entity within each state;
- this may not mean a policy change, for the above reasons and many others.

That said, congrats!
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  #6  
Old 12-19-2006, 11:44 PM
ZorroSF ZorroSF is offline
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well surgery date is the 27th. I didn't lose the 20lbs I wanted to, but I'm 34 and should fair well.

I'm most worried about the scarring that occurs around week 3. I read Deuce's thread and just about flopped my head on my keyboard a few times aganizing what I got myself into, but I think I'll ride it out first. I had the same problem as him; protrusion that kept rubbing up against the nerve root for 10 years. I have some scarring, but the hospital system hasn't seen any reason to stop yet. I go in for a pre-op this friday. I anyone wants me to keep a log on this forum about my surgery in san francisco let me know. I'll start taking notes soon.
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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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