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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 02-08-2009, 10:55 PM
gjmorse gjmorse is offline
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Smile Aetna just paid 100% for my 2 level adr at Stenum

Aetna just paid 100% for my 2 level adr at Stenum

I had Aetna with out of network coverage. I had to pre-pay Stenum out of my pocket.

Included in my submission to Aetna were the following;
1. Included the surgery detailed bill from Stenum.

2. I then added a cover letter with the complete history of my back, including the different treatment options that i could have done instead of ADR.

3. I also included the x-rays from Stenum.

4. I also included the email correspondance from Stenum with the surgeons.

5. I also included my Bank of America Money transfers to Stenum.

Then I submitted this large package to Aetna. Starting a month after submission I called them every week.

In the end Aetna paid 100% and even late interest. I am very happy with them.
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Gary Morse
2 Maverick ADRS - Stenum October 24, 2008
L3-L4, L4-L5
Great Experience! (at Octoberfest 4 days after surgery)
What I did right - strong abs and stretching before surgery.
What I did wrong; Not enough stretching before surgery. Muscle cramps not under control.
Worst part after surgery; The cramps - finally fixed with potassium, magnesium, and calcium supplements plus lots of water.
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  #2  
Old 02-09-2009, 11:49 AM
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Harrison Harrison is offline
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Default Wow!

That's another milestone! Blue Cross Blue Shield has paid for a two level at Stenum as well...
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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  
Old 02-09-2009, 07:31 PM
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trkdoc714 trkdoc714 is offline
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That's great news! How long did it take you from when you first filed the claim until they sent you the reimbursement?

I'll bet that's a load of pressure off of your shoulders.....and new discs

Congratulations!

Bob
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04/06 L5/S1 Rupture
05/06 MRI shows DDD @ L2-S1
06/06 Diskectomy/ Laminotomy L5/S1
04/07 Recurrent Disc L5/S1
4 Ortho and 1 Neuro Surgeon, 5 MRIs, 1 EGM, 1 Myleogram & 11 EDIs later:
03/27/09 L4/5 & L5/S1 Maverick disc at Stenum
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  #4  
Old 02-09-2009, 09:21 PM
Robert G Robert G is offline
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Default Can I get the name of the Aetna Plan??

I would like to look at the terms of coverage and compare it to mine. I just need the plan name, I think the brochures are online?

Thanks,
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  #5  
Old 02-21-2009, 03:29 PM
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trkdoc714 trkdoc714 is offline
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Gary,

I just started the precertification process with Aetna. No precertification needed but they have a clinical bulletin (#0591) restricting coverage to FDA approved devices e.g. Charite or ProDisc. How did you get that one past the goalie?

I think that's the only hurdle I have left before I can be comfortable about being reimbursed by Aetna for the Maverick disc. Otherwise I'll have to sell one of the kids or borrow money from Rocco's Scrapyard and Loan Company. I'd bet I could get in trouble for either one of those options.

Thanks for your help,

Bob
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04/06 L5/S1 Rupture
05/06 MRI shows DDD @ L2-S1
06/06 Diskectomy/ Laminotomy L5/S1
04/07 Recurrent Disc L5/S1
4 Ortho and 1 Neuro Surgeon, 5 MRIs, 1 EGM, 1 Myleogram & 11 EDIs later:
03/27/09 L4/5 & L5/S1 Maverick disc at Stenum
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  #6  
Old 04-20-2010, 12:56 PM
tkdodger tkdodger is offline
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Quote:
Originally Posted by Harrison View Post
That's another milestone! Blue Cross Blue Shield has paid for a two level at Stenum as well...
Can you give me more info? Which of the BC BS entities approved a 2 level ADR at Stenum? I am considering that very thing!
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  #7  
Old 06-28-2010, 10:40 AM
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Jmbeam Jmbeam is offline
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Harrison

Can you please reply back to the previous question? I can bet that many people are hanging on your answer.
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  #8  
Old 06-28-2010, 10:47 AM
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Harrison Harrison is offline
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Unhappy

Folks, I am only reporting on what patients in these forums have posted. Sorry I can't address many (or most) of the insurance questions. There's enough questions on insurance to keep five Harrisons busy all week!
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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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  #9  
Old 01-06-2013, 08:23 PM
gil gil is offline
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gjmorse,
This may make sense to Aetna since Germany surgery costs less than US. So you ended up paying for your travel and lodging expense? Could you tell me what Aetna plan you have? - I have an Open Acess HMO.

thanks,
gil
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Multi-level (c5/6-c6/7) surgery recommended because of bone spurs
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  #10  
Old 02-11-2014, 02:09 AM
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MMsC5-6-7 MMsC5-6-7 is offline
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gjmorse,

I'm new to this forum so not sure how to check, but I hope you're still posting your progress on this site?!

I have just sent my records to Dr. Bierstedt in Germany to see if I'm a candidate for 2-level ADR. I also have Aetna insurance (Aetna International), and if I am a candidate for the surgery, it would be very helpful if I could provide them with information on your approval to help my case. Would this be possible?

Also curious to see how you're doing? If anyone has more information about Aetna approvals that would help move my approval process along I would be grateful.

Wishing all the fellow spine travelers here the best of health and healing!

Melissa
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DEC 2013 MRI/CT scans show severe spondylosis at C5-C6/C6-C7; moderate at C4-C5
Spondylotic spurs C2 thru C7
Left vertebral artery medial loop at C4 body
Foot / hand numbness
Throat tightening and on/off lump sensation
Neck pain, upper back ache between shoulder blades
52 years on this planet (most of the time)
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