Community generated Insurance Appeal Letter

[DWebster]

Hang in there Kevin!! I know what you mean about the pain I am just one big ballof pain from the ribs down it is very hard, lets help each other get thru this. I am gload to see this is not dead, it seemed to have lost intrest for a while.

Patty, if you could get that info it would be outstanding, we need to hit this issue from every angle we can, it seems to be a big one with the insurance companies.

Ans, you also bring up a good point with fusion track record, it is the gold standard but I think it is fools gold, we should get data to compair.

Can people start signing up to research information. We should have at least two people for each item.

Thanks everyone
Dave W

[Nichole]

I would be happy to sign up to do research. What would you like me to research?

[patty]

ans,
I had a brief conversation with my statistician friend. There are ways to exclude particular datum from a particular study, but if the protocols are considered flawed by US standards, the study data can not be considered. Hate to seem like a downer a bit here, but I am a realist.
I have the transcript from the FDA meeting in June 2004 where the stats guys talked about the data.I want to look closer at this and maybe get my friend to look at it. He recently lost his dad and is trying to make up 2 weeks worth of work at the moment, so this will have to wait until next week. Hiring a stats consultant would help with this process. I will also ask how much it might cost to do so.
Also, I found an internet book on the appeals process. I downloaded it but did not have a chance to read it last night. I will look at it tonight.

Patty

[DWebster]

Nichole,
Do you have an interest in an area? I will try to go thru and make a list of the things we have come up with so far. I can't sit to long at the computer any more my pain is just getting to bad.

Harrison,
Were should we bring this information togeather? do you ahve a place to accumalate this much stuff on here? or should everyone just e mail it to whom ever is going to assemble it?

Dave

[Harrison]

Dave, you can start a new thread, or we can collaborate on the project by using the private forum -- ADR Incubator. The "secret" password is peace, for all those helpful folks that want to help "bake" this to fruition... (Hmmm, baked fruit? I must be hungry.)

[Nichole]

DWebster, let me know the area's and I will let you know where my special interest is....hehehehe I am actually interested in all areas but am sure I can pick a few that are my fav's.

Patty, I have the entire manuscript if you dont have it. I have it as a legal document and can email it to you if you would like.

I met with a rep from DePuy who will be attending my appeal with me yesterday and we chatted about some ways to approach this. He is going to sit down on Friday and go thru all that I have sent my insurance already and the rest of the information that he has and compile something then. I am really excited about his help. He sounds very educated regarding the disc(better be since he is a sales rep for the Charite') and sounds like he can possibly make a difference. We are also going to use the fact that Aetna is now considering this non-experimental. Generally once one insurance approves the rest will follow shortly. I just hope it's sooner than later.

Anyway, let me know the different areas and I will choose a few then.

I hope that more people volunteer to do some research as this will help us all.

[Cat-mt]

Could we get a list of the different insurance company's that are now approving ADR. Anyone that has gotten a yes from their ins. co. or anyone that has read about an ins. co. that is now paying could post somewhere. Just a thought. Thank goodness for my laptop, I have been in bed for 2 days, just because I turned the wrong way.

[ans]

Cat-mt: good question. (Sorry that as a veteran you have to struggle like this).

Sorry, no idea how Tricare operates (no pun intended).

Empire Health Choice, formerly Empire BC/BS of NY ok'd a two-level disc replacement (in small print they say that they can deny the treatment though). Not clear if BC of CA w/pay secondarily and utilization review nor doc's financial people can give honest answer. Atena's coming around too, as I'm sure others:

http://adrsupport.org/private-cgi-bin/ultimatebb.cgi?ub...t_topic;f=3;t=000187

Best of luck, ans

[Smiley]

I'm interested in helping out with research also. I have been reading some research studies on ADR (specifically the Charite). I haven't been able to get much on European research studies, but have a little. I would like to try to help in some way with this project, but I don't really know what would be helpful to do. I have a couple questions:

What format do would be best to report the results in?

What subjects specifically do we want to research or address? Some areas I would think might be important include:
- Effectiveness of adr (including ability to work, functioning, pain, satisfaction...)
- Comparison of results with fusion
- Results over time (especially long-term)
- Complications of adr
- Improvements and advances of adr surgical technique over time since its inception

What do y'all think?? I would like to know how I might be able to help.

[Melissa]

I have HighMark BS PPO and am trying to get approval for a 2 level charite. Dr. McAfee's office has told me that they have recieved approval once before from that insurance for a 2 level procedure. I also had another Dr.'s office tell me that they had approval from my type of insurance, but it was a the plan for Fedral employee's that would only approve ADR, but that was when I tried to get approval for the Prodisc, I don't know if that make a difference, but Carol from McAfee's office thought that would give us good grounds for if/when it comes time for the appeal if it was denied based on discrimation or something, I'm not sure.