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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
10-26-2013, 02:19 AM
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Any Bierstedt patients getting reimbursed?
I've read about several fortunate folks who got BCBS to reimburse them to varying extents after surgery with Dr. Clavel (the Worldwide rider seems to be key to success). Does anybody know of any patients of Dr. Bierstedt who were reimbursed by BCBS?
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#2
10-26-2013, 11:06 PM
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I am currently working on it. I've submitted all of my data to BlueCard Worldwide two weeks ago. To date - no one knows where it went. I've played this game with them before - I don't give up. Game on!
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2006 C 5/6 discectomy and fusion 2008 Automobile Accident C3/4 leftward bulging of intervertebral disc mild narrowing of left lateral recess C4/5 central and rightward bulging of disc and osteophyte causing mild right neural foramen stenosis narrowing and right lateral recess narrowing C6/7 Central disc bulging and osteophyte and hypertrophy of ligamentum flavum canal stenosis and narrowing of bilateral neural foramina Sept 9, 2013 Scheduled with Dr. Bierstedt C4/5 & C6/7 M6
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#3
10-27-2013, 08:12 AM
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Good Luck Laura! You might have a good shot seeing that you have the Worldwide rider. I think I need to look at getting a Worlwide rider in case I need cervical intervention in the future. I don't think that Obamacare is magically going to start covering
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*9/10: Unstable pelvis & SI joint, sore IT band. Chiro care, I would shift out hours to days after adjust *12/10: PT & chiro *4/11 to 11/11: 5 sessions prolo and 3 prolo w/ PRP *12/28/11 ESI L L4/L5 - 1/13/12 ESI R L4/L5 - 1/24/12 L SI joint capsule - 3/8/12 TPI - 3/23/12 L L5/S1 - 4/11/12 ESI caudal - 5/23/12 TPI - 7/10/12 Facet inj L3/L4, L4/L5, L5/S1 *9/12/12: 30 - DRX9000 *12/21/12 schedule. for L4/L5 fusion-CANCELLED 1/7/13 *7/16/2013: 3 level M6(S1-L3) w/ Dr. Bierstedt
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#4
10-27-2013, 07:21 PM
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I'm not exactly quite sure what "Obama care" will cover, but I'm sure it won't be the latest and greatest!
My next step is contacting the Board of Directors of our Labor Board (the powers that be). I don't care how long it takes, I will be a thorn in their side until they relent.
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2006 C 5/6 discectomy and fusion 2008 Automobile Accident C3/4 leftward bulging of intervertebral disc mild narrowing of left lateral recess C4/5 central and rightward bulging of disc and osteophyte causing mild right neural foramen stenosis narrowing and right lateral recess narrowing C6/7 Central disc bulging and osteophyte and hypertrophy of ligamentum flavum canal stenosis and narrowing of bilateral neural foramina Sept 9, 2013 Scheduled with Dr. Bierstedt C4/5 & C6/7 M6
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#5
10-27-2013, 11:34 PM
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I'm keeping my fingers crossed for you, Laura! I've been sitting on the fence for a while now, but it's looking like I'll be heading to see Dr. Bierstedt next month for two levels (L3/4 and 4/5). Would be great to compare notes as we battle for reimbursement!
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Nov 2010: herniated L4/5 led to back pain, sciatica and foot drop Dec 2010: back pain resolved, sciatic pain and foot drop worsened Jan 2011: micro-discectomy resolved sciatic pain and foot drop; back pain returned July 2012: discogram reveals L4/5 and L3/4 have grade 3 annular tears and produced concordant pain Nov 12, 2013: 2-level ADR (L3/4 and 4/5) by Dr. Bierstedt
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#6
10-28-2013, 01:37 AM
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My doc had to resubmit the appeal stuff because for some reason Aetna doesn't have it after a month.
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Chris Back and Neck Pain 30+ years, Chiropractic care Several Epidurals and Blocks over past 5 years Awaiting Insurance for 2 ADR Lumbar L5-S1 L4-L5 Discogram showed Shredded L5-S1 5 YO MRI of neck shows straightening of cervical spine, issues at C4-5 & C5-6 and C6-7 (central disk protrusions, bilateral uncovertebral joint arthropathy, moderate neural forminal stenosis, severe central stenosis with cord compression) Aetna approved C6-7 replacement, scheduled for 11/17 
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#7
10-29-2013, 12:08 PM
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3 level
Here, I am doing the waiting game, I had a discectomy, at the L2-3 level, and the MRI (Five Doctors total) showed severe DDD at L45 and L51, There is quite a bit of pain at the L51 level.
I am sure the VA and the Insurance are going to waffle on this one. Time will tell, may take a couple of weeks, but I would prefer to have this done and move on. Jerry PS, I have BCBS, but not sure about the WW Rider.
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#8
10-30-2013, 09:30 AM
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Insurance reimbursement is such a gray area. All I can say is that it is new territory and don't give up. In my experience....these companies count on the individual "giving up." Most people accept the answer because it does require a lot of work. My $40,000 was a lot of work to make, thus I will do the legwork and paperwork to retrieve as much of it as possible.
I am rewriting an appeal with a novel of information of pre, present, and post surgical data. I believe the key is keeping everything simplified and organized. If they can't figure it out - they'll just throw it in the pile of "we never got it." Please post any positive results - this is more difficult that recuperating from surgery.
__________________
2006 C 5/6 discectomy and fusion 2008 Automobile Accident C3/4 leftward bulging of intervertebral disc mild narrowing of left lateral recess C4/5 central and rightward bulging of disc and osteophyte causing mild right neural foramen stenosis narrowing and right lateral recess narrowing C6/7 Central disc bulging and osteophyte and hypertrophy of ligamentum flavum canal stenosis and narrowing of bilateral neural foramina Sept 9, 2013 Scheduled with Dr. Bierstedt C4/5 & C6/7 M6
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