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| The Big File All issues not easily categorized in the above forums are here. Comments on general health, diet, "getting comfortable," and more are here. |
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#1
07-12-2005, 12:39 PM
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Just found out that CIGNA PPO denied my two level with Dr. Regan scheduled for Aug. 2nd
 Reason given: Unproven and experimental (no surprise). What a roller coaster. #@"*!# insurance pin-heads....... Brad
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Brad, 2-level Activ-L ADR by Dr. Bertagnoli Oct. 18th 2005. L4/L5, L5/S1. ABSOLUTE SUCCESS (so far) 
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#2
07-12-2005, 12:51 PM
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Brad,
I am so sorry to hear this. You are in my prayers. Talk with Regan and see if he can make you a deal. He may need some business on Aug 2. Hope to see you at Lunch tomorrow.
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Paulette ProDisc L5-S1 W/Dr Delamarter Aug 23, 2005 L5-S1 DDD Diagnosis 12/04 T-12 Compression Fracture 10/04 C-7 Spines Process Fracture 5/99 http://prodisc2.blogspot.com/ You are my Rock God in you I can do anything
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#3
07-12-2005, 01:04 PM
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Hello Brad!
I am sorry to hear you were denied, but I wasn't surprised. I recently got my appeal back from UHC and, of course, stood by their denial because "experimental/unproven" It is very upsetting how insurance can do that. People can even have that same insurance and one will get approved and another denied because they live in a different state or insurance region. I even asked mine if they would pay for the surgery and I would pay for the Charite. Of course they said "no". It will take some government intervention...some across the board standards. OK...I will get down from my soap box. Hugs, Kat
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1/91 Fell L4/5 L5/S1 herniation 11/92 disketomy-No pain! 3/03 Pain L4/5 L5/S1 DDD 5/04 TBI/Dr Zigler recommends 1 level ADR 4/05 UHC denies Charite. Appealed-Denied again 6/05 Scheduled fusion 6/28 6/05 Fusion cnxl'd- 6/05 Fusion w/NS 7/26 at 7:30am
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#4
07-12-2005, 06:56 PM
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Brad,
I'd suggest getting together an appeal together ASAP. Mark can help you. In the mean time, call our doc to see if you can cut a deal. As I told you on the phone; for his fee he is charging me the customary and reasonable rate - which IS actually pretty reasonable! Everyone is waiting for Medicare to start coughing up in a few months. Once that happens the other insurance companies will fall like dominos.. Hope to see you at the lunch. Dan
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Age 34 DDD L5-S1, bulge and Grade V annular tear. SED 2/15/05 - no luck Charite @ L5-S1 8/2/05 with Dr. Regan Struggling with facet joint pain.
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#5
07-13-2005, 12:48 PM
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Thanks for all the support everyone. I really do appreciate your prayers and concern. I have started the appeal process and will also talk to Dr. Regan but they have had to pull me from the schedule Aug. 2nd. When I asked what it would cost if I pay for it myslef I was quoted about $80,000. $58,000 of it was the hospital stay at Cedars alone (for a two level).
This thing is out of control right now (in my opinion) not in our favor as patients. Paulette, Unfortunately I have a visitor in town today so I won't make the lunch but I will be there is spirit. Thanks again, Brad
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Brad, 2-level Activ-L ADR by Dr. Bertagnoli Oct. 18th 2005. L4/L5, L5/S1. ABSOLUTE SUCCESS (so far)
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