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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 10-14-2017, 01:09 PM
ia75 ia75 is offline
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I you don't mind sharing, which insurance did you get the ADR approved through? I was just (repeatedly) denied by BCBS FEP and I am quite devastated. Since open season is coming around, I am hoping to switch to someone to try again! Any advice/input is highly appreciated!
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  #22  
Old 10-14-2017, 01:45 PM
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Tatonka_usn Tatonka_usn is offline
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Quote:
Originally Posted by ia75 View Post
I was just (repeatedly) denied by BCBS FEP and I am quite devastated. Since open season is coming around, I am hoping to switch to someone to try again!
As someone with BCBS FEP, I'm in the same boat. If you receive any feedback, would you be willing to pass it along...since I'm considering Europe vice dealing with FEHB at this point
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4/07:LBP + radiculopathy=severe L5-S1 herniation , 7/07:Micro-D, 08-09:Reherniation, 09-17: periodic residual symptoms (conservative modalities to maintain "stability" = prolotherapy, ESI/nerve blocks/facet injections, chiro, massage, phys ther), 7/17 pain in neck/right shoulder radiating into hand (no trauma involved), 7-10/17 Conservative treatment to date include physical therapy/dry-needling/facet-injections (C4/5 to C6/7). Researching surgical options should progression continue.
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  #23  
Old 10-14-2017, 04:54 PM
GKTM300 GKTM300 is offline
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Yeah your vertebrae might have been porous had you been inactive for quite a while. I had epoxy injected into my verts n thank God it held. Laterally I think means they come in from the side of your obliques? Good luck bro I wish you a painfree life. But your mess seem kind of light how much pain were you in that you went for surgery?
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12/22/04 blew L4-5 and L5-S1 out lifting wrong
4/1/05 back to work thanks to Oxy
11/11/13 hurt back lifting again
6/6/15 last of many MRI L4-5 medium paracentral bulge with juice leaking and mid to left bulge on L5-S1
No invasive procedures except steroid shots that did nothing n hurt wicked bad
9/24/2016 Adr surgery Bertagnoli>1 year doing great
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  #24  
Old 10-29-2017, 05:20 PM
ia75 ia75 is offline
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Join Date: Oct 2017
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Default Still waiting

Quote:
Originally Posted by Tatonka_usn View Post
As someone with BCBS FEP, I'm in the same boat. If you receive any feedback, would you be willing to pass it along...since I'm considering Europe vice dealing with FEHB at this point
Hello, Tatonka_usn,
sorry for the late reply, I've been all over the place lately. My surgeon in Miami all but abandoned me after the initial denial, so I ended up retaining an attorney. I am still trying to get an urgent appeal processed but I am not really sure if that will do anything. I am from Florida, which state are you in? I contacted my senator here after BCBS kept stone-walling me and brushing me off. He asked me to sign a consent form because of HIPAA, no idea if this will make a different...for what it's worth, I am not going down without a fight!

I just got evaluated by Dr. Bergatloni in Berlin, Germany. He is supposed to be one of the best but also pricey: for a one-level ADR, I got a price estimate for $32,000 Euros. I am still waiting for the evaluation from Dr. Dasai (Cologne, Germany). He also has a good reputation. I heard that the Texas Back Institute may offer cash-prices as well...

I am so confused in terms of what device is best: I was initially going for the activL (that's the one the surgeon in Miami uses), TBI I believe does the ProdiscL, and Dr. Dasai uses the LP-ESP...

What is your status/plan?
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42 y.o. female, athletic build, otherwise healthy
L5-SI: Severe DDD with subtotal disc collapse, mild to moderate bil. foraminal stenosis.
2007: car accident, mild herniation, intermittent pain.
2012-17: pain chronic, progressive, resistant to conventional treatment.
06/2017: Discogram, MRI
10/04/2017: ADR surgery denied by BCBS (FEP),

Pain is severe and disabling
04/04/2018: ADR surgery using LP-ESP disc with Dr. Desai
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  #25  
Old 11-28-2018, 07:23 PM
Goforblue1 Goforblue1 is offline
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Hello! Just wondering how you are doing after your ADR with Dr. Desai?
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