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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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  #21  
Old 06-14-2007, 12:43 PM
LBP LBP is offline
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Join Date: Aug 2005
Posts: 446
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Best wishes to you in your upcoming procedure. Keep us posted!
__________________
Injured 9/01
Annular tears L4/5 & L5/S1
denied adr by insurance for 2 level charite as well as hybrid fusion at L5/S1 with Charite at L4/5.

New ins paid for 2 level lumbar prodisc surgery on 4/7/08 (at age 39) with Dr. Westerlund, at Core Orthop
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  #22  
Old 06-18-2007, 01:17 AM
epiphaknee epiphaknee is offline
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Join Date: Dec 2005
Posts: 21
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This is a classic anti-trust case fact pattern. Insurance companies or any companies conspiring/colluding in an anti competitive manner to reduce competition (e.g. choices) for consumers/patients. State and federal Attorney General's should be interested in this bad behavior. Even Medicare wrote that denying claims for all ADR surgeries would have a cooling effect on this new procedure, due to their power and influence in the medical community. This may not rise to a RICO case, because in such a case we need a criminal enterprise, and anti-competitive actions may not rise to crimes. This would be a good story for an investigative reporter (60 Minutes or Anderson Cooper....)



Quote:
Originally posted by LBP:
Coley,

with the news about the ins companies getting together and almost seeming to collude on how to create a new policy...I am wondering if there is anything rising to the level of criminal activity for a district attorney to investigate...not just an invidual civil lawsuit. Your facts are very unique. Do you have anything in writing about the reasononing? Like there was a meeting with out ins co to pay only what medicare is paying?

Re your pain and surgery. I am sorry for your pain and I don't know anything about the other procedure you mentioned. best of luck. I just find what happened to you so alarming for the future of ADR.
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  #23  
Old 06-22-2007, 08:40 PM
Ouch! Ouch! is offline
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Join Date: Apr 2007
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D,
I am so sorry for your insurance problems. I hope you can get adequate coverage for this new proceedure you are considering.

Jane
__________________
DDD L5/S1
No Fusion, please.
Looking for ADR direction
20 years of back problems, no known specific cause
5/9/07 at Consultation Texas Back Institute, Dr. Zigler
7/5/07 Insurance struggles
7/19/07 Prodisk surgery, TBI, Dr Zigler
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  #24  
Old 06-22-2007, 10:06 PM
D. Coley D. Coley is offline
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Join Date: Jan 2007
Posts: 12
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Update:

AxiaLIF fusion surgery is scheduled for July 23, 2007 @ 10:30 a.m. @ Northwest Surgical Hospital in OKlahoma City.

This is the quickest surgery date available because the surgeon will be out of town....oh well, I can't wait any longer for the disc replacement. Like the surgeon told me, it may take months or years for the insurance co's to agree to pay a reasonable amount for the surgeons services. If I try to wait, I may be bed-fast even on the pain pills.
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