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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 02-08-2008, 08:35 AM
mgs32 mgs32 is offline
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Hi All,

My insurance has finally approved my appeal for a 1 level cervical ProDisc! After sending in an 88 page long appeal, having that looked at by two medical directors and an outside review board, they've finally decided that the surgery is medically necessary, and there is "some" data to suggest cervical ADR is effective

HUGE thanks to the Insurance Warrior, Laurie Todd. Between her amazing book and all of the emails she answered for me immediately, she was an incredible help and a large part of my success.

If anyone needs help with approval for a single level cervical ADR, feel free to send me a message. I'd be more than happy to help.
__________________
25 y/o female
Pain in neck, shoulder, arm, hand since Spring '06
MRI showed herniated disc at C5-6, DDD at C6-7
Doctor has recommended one level ProDisc-C ADR

ProDisc-C March 18,2008
Felt good for a few months, now pain in right side of head, shoulder, neck, arm, hand
MRIs and CT Scan suggest problem with facet joints
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  #2  
Old 02-08-2008, 10:33 AM
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CindyLou CindyLou is offline
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Good for you! You are the trendsetter! The one who paves the way for future ADR replacement! We need "precedent." And a big hooray to our Insurance Warrior!!
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CindyLou
bicycle accident 6/19/01
2 compression fractures, T12, L1;
vertibroplasty @ above levels, 9/15/01
4/06 hip labral tear repair
4/07 Lumbar ProDisc replacement by Dr. B., 3 levels; L3-6
7/2/08 ALIF of L6-S1
7/30/08 Removed bone cement.
8/7/08 Diagnosed with pulmonary embolism, double pneumonia, collapsed left lung, pleurisy, pleural effusion.
3/10/09 right SI Joint Fusion; seeing light at end of tunnel, for first time in 8 years!!
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  #3  
Old 02-08-2008, 10:53 PM
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Terry Terry is offline
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A Big WOW!

Terry Newton
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1980 ruptured L4-L5
1988 ruptured SI-L5
1990 ruptured C5-C6
1994 ruptured C6-C7
1995 Hemi-Laminectomy C5-C6, C6-C7 Mayo Clinic
Bicycle Accident 2004
MRI, EMG, Facet Injections, Epidural Blocks, Lumbar Discogram.
Stenum Hospital Surgery November 4, 2006
Prestige Disc C5-C6, C6-C7
Maverick Disc S1-L5, L4-L5
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  #4  
Old 02-11-2008, 08:09 AM
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Harrison Harrison is offline
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Congrats! I am happy to hear that our friend Laurie has helped yet another patient!

: )
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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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  #5  
Old 03-17-2008, 06:37 AM
mgs32 mgs32 is offline
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Hi All,

I just wanted to keep everyone posted and let you know I'm heading in tomorrow for my ProDisc. It's exactly three months after my last scheduled surgery, when I found out the night before that insurance was a no-go. So, I'm anxious and scared to death about the surgery, but hopeful that insurance doesn't back out again last minute. Hopefully everything will go smoothly and I'll be feeling much better in a few weeks and get back to being a normal 24year old.

Luckily my Mom is able to take off this week, and my fiance is up from New Jersey with me for two weeks to make things a bit easier. I have chloraseptic throat spray, straws, lots of pajamas, and tons of movies to entertain myself over the next few weeks. Does anyone have any other last minute suggestions for things I need for the time right after the surgery? Or any suggestions/hints on how to make this work out the best possible?

Thanks everyone for your help!

Best wishes,
mgs32
__________________
25 y/o female
Pain in neck, shoulder, arm, hand since Spring '06
MRI showed herniated disc at C5-6, DDD at C6-7
Doctor has recommended one level ProDisc-C ADR

ProDisc-C March 18,2008
Felt good for a few months, now pain in right side of head, shoulder, neck, arm, hand
MRIs and CT Scan suggest problem with facet joints
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  #6  
Old 03-17-2008, 07:37 AM
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Terry Terry is offline
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Posts: 1,210
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mgs32:

You're in luck! Cervical recovery is a lot easier than lumbar. There is sometime a bit of swelling that takes place after surgery. Be careful with food that you cut little bites to swallow. You should do fine and, at a young age, should recover fully. Take care and good-luck with your surgery. It sounds like you are in good hands.

Terry Newton
__________________
1980 ruptured L4-L5
1988 ruptured SI-L5
1990 ruptured C5-C6
1994 ruptured C6-C7
1995 Hemi-Laminectomy C5-C6, C6-C7 Mayo Clinic
Bicycle Accident 2004
MRI, EMG, Facet Injections, Epidural Blocks, Lumbar Discogram.
Stenum Hospital Surgery November 4, 2006
Prestige Disc C5-C6, C6-C7
Maverick Disc S1-L5, L4-L5
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  #7  
Old 03-18-2008, 11:50 AM
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Harrison Harrison is offline
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Congrats! Wow, that time went by fast...it seems like just a days ago we were talking about this!

Terry's right, but no trampolines or cartwheels for you in the coming weeks! Take it slow. When you are up to it, start a new topic in the post-op forum...
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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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  #8  
Old 03-18-2008, 12:08 PM
chasswen chasswen is offline
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mgs32
wishing you a speedy recovery for todays surgery.
my positive thoughts and prayers will be with you.
May The Force Be With You!!!
chuck
__________________
ddd 1990
2003 mri,xrays,shots,emg
2004 discogram ouch pos l4 l5
facet block neg
lost all appeals BCBS 5 months of that
3 surgeons later
surgery with dr. bertagnoli aug 2nd 2006 in Bogen Germany Successfully ProDisc-L L-4 L-5
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  #9  
Old 04-01-2008, 11:49 AM
mmarsh mmarsh is offline
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Posts: 79
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MGS

Hope all went well and by now you're feeling good. If you could give me some info for my appeal I'd appreciate it. Your surgery date, location and ins co name. Your name or initials would be good but not necessary.

Missy
mdm798@aol.com
__________________
fusion L4-5, Dynesys rods L3-4, fusion c5-6 and C6-7, current problem C-7/T-1
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  #10  
Old 08-05-2008, 06:05 PM
Laura Laura is offline
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Join Date: Jun 2008
Posts: 1
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Hi

Am waging my own appeal and live outside Boston.
Have hired an attorney. Was wondering what insurance company finally approved?
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