News! Insurance Coverage for ADR

[wbaker68]

How in the heck would one submit a bill thru BCBS PPO with no codes as the receipts are all from overseas?

Just in process of putting what I have together, but know codes are required.

Suggestions?

[Harrison]

"Billing" Bill,

the doctor's billing office usually does the billing codes, so maybe you can call them? If that doesn't work, I can contact someone who may be able to help? Stating the obvious, since ADR is new, there may not be a new procedural code yet for ADR...

Richie Rich

[wbaker68]

Its overseas and I assume the codes don't apply. But we all know what they say about assuming!!I just found form online for BCBS internation form for services rendered outside the US. I believe that is what I am going to need to file.

Going to put paperwork I have together and start process next week. We'll see what happens.

[queenofhearts]

wbaker - my insurance company needed a translation of the item or procedure - then they applied the corresponding US code. It sounds easier to submit it using an international form, but there are companies that will translate the language on the bill if it is in German (or any other language) if necessary.

[wbaker68]

Thanks, I will keep that in mind, I haven't even felt like doing anything on it as of yet. Hopefully I will get off my butt soon and do it. I just feel like its a loser and hope to get a big suprise!

Take care,

bill

[queenofhearts]

I know what you mean.....I was surprised when I won my appeal and got paid back.

Now my insurance company has set themselves to pay for my cervical discs in Europe. They've already paid for one "experimental and investigational" surgery - it'll be hard for them to argue against paying it this time around!

[Harrison]

PS: I got paid TODAY..all my money back for ADR (less $500 deductible). Amazing, what a ridiculously long journey. I hope these chapters are history for all future patients.

[TXTony]

Thanks, Jill, for identifying the ADR that you have, a PD (ProDisc). There are significant differences between the various brands and among various revisions within a brand.

As with any other mechanical device (a car, a truck, a baby carriage), with ADRs it doesn't matter whether you are having a good result or a bad one, it is important when relating your experience to say which one you are talking about.

Regards,
Tony

[Justin]

I was unsuccessful with my appeals. Dr. Fenk-Mayer was at my appeal via teleconference----AND I still was denied. It was blatantly obvious that the insurance company (BlueCross BlueShield of New Mexico) had their mind made up before I walked in the room.

I decided to take my case to the NM State Insurance Comissioner--AND I was still denied. They just "cut and pasted" BCBS explanation to uphold my denial.

I am STILL pissed about this as I worked MANY, MANY hours on my 1000 page binder (I even had Dr. Fenk-Mayer on the phone). All I can say is "What the He!!"

I know some people that wrote a paragraph explanation as to why they should be reimbursed and they were---however, for me I spend 300 hours on my reimbursement for nothing.

Fight till the end against these evil insurance companies!

Justin