ADRSupport Community  

Go Back   ADRSupport Community > General Discussion > The Big File

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.


Reply
 
Thread Tools
  #1  
Old 03-31-2005, 11:41 PM
misty misty is offline
Junior Member
 
Join Date: Mar 2005
Posts: 7
Default

Hi guys,

I realize that this may not be an entirely new topic, as this is my first time on this site, hopefully you can tolerate my ignorance I'm trying to help my husband make a decision about his herniated discs.

I have noticed lots of conversation about insurance coverage with Blue Cross Blue Shield. I haven't seen any mention of Federal BCBS, so I'm not sure that there is any difference between federal coverage and basic coverage. Does anyone know what difference this might make?

I called BCBS in Washington DC and they said that they handle all of the overseas claims. They also told me that any doctor overseas would automatically be considered a preferred provider, and that the ADR procedure (or any other procedure that is medically necessary) was guaranteed to be handled as if you were stateside. (She said that the only way that they would not pay as usual is if a procedure is strictly cosmetic, which of course this is not The one exception to the preferred provider coverage was that since they do not contract with Stenum Hospital in Germany, if the amounts that the hospital bills is above what is "usual and customary" I would be required to pay the difference. (Whereas in the US the provider just writes off the difference and I'm not responsible for it.)

I live in Wyoming, and have not called my local Wyoming BCBS. Is that where I am going to run into problems and have to appeal? The lady I talked to sure sounded like she new what she was talking about, but she is the only person I have asked so far. I will call Wyoming BCBS tomorrow, but was just very curious if Federal coverage was any different.

Any info would be greatly appreciated! You seem like a pretty friendly crew, and I'm glad that there is place to post questions like this. Thanks again! Misty
Reply With Quote
  #2  
Old 04-01-2005, 03:31 PM
MrBee MrBee is offline
Banned
 
Join Date: Oct 2004
Posts: 42
Default

Hi Misty,

It sounds like you are on the right path to arrange payment of your ADR surgery overseas. My insurance (Health Net) wouldn't pay for it here in the trial or so far are they considering paying for my surgery which was done last August at Stenum.

I am not conversant with BCBS; however, I will be soon as I am changing my insurance from the HMO to BS of Cal PPO starting May 1. So I can�t help much there but there are some others here on the forum that has posted about BCBS paying for it. I guess you can try the search screen to find those.

If I may without upsetting you, a word of caution about Stenum. I had my surgery done in Aug 04 in a group of 10 Americans. Out of that group 4 of us have had to have revision surgery of some kind. Mine being a complete removal and implantation of a larger size. The first one had sunk into my vertebrae.

I returned on Oct with one of the persons who were in my August group. She had a Dynesys fusion performed to help straighten out her crooked implants that caused her vertebrae to go lopsided. After my surgery I woke up to a problem in my left leg, which was an occlusion to my left iliac artery. I am now 4 months post op and still waiting for my next surgery to bypass this closed artery so I can walk again.

My HMO has messed me up, so I changed to the BS PPO so I can go anywhere and get this done. It is a complex surgery which has a limited success and a high risk associated to it. The thing that has me very upset is that people like you are being marketed through the GETADR site and they show that Stenum has had zero revision surgery and zero vascular injury.

This is deceptive advertising. Not to say you can't go to Stenum and get a successful ADR surgery others have. Even in my group in August there are 4 to 5 that are doing OK. But I feel that hiding the truth and misrepresenting the truth is a major road sign to hold up and get more data about Stenum. I am probably the worst case that Stenum has performed.

So take this for what is worth and I hope you find the best ADR doctor and hospital for your situation. Of all the ADR doctors I interviewed here and abroad, only Dr. John Regan was very truthful and honest about his ADR errors.

Thank you and the best,

Willie
Reply With Quote
  #3  
Old 04-01-2005, 03:40 PM
Alastair Alastair is offline
Senior Member
 
Join Date: Oct 2004
Posts: 2,391
Default

Hi Misty,
There is Dr Zeegers and Dr Bertagnoli in Germany who are excellent and amazingly experienced - -- contact details in FAQ`s
Best
Alastair
__________________
ADR Munich 26th July 2002 L5/S1. Aged 82 now
Your best asset is your health
My story is here
http://www.adrsupport.org/alastair.html
Thank goodness for Dr Zeegers I am painfree
I am here to help,I live in the UK


I now run the UK spine site and can be contacted at

www.adrsupportuk.com/
Reply With Quote
  #4  
Old 04-01-2005, 09:30 PM
misty misty is offline
Junior Member
 
Join Date: Mar 2005
Posts: 7
Default

Thanks Alastaire! We still have not made a decision about which doctor to use, so any experience you may have (good or bad) that you could share would be greatly appreciated! Take care! Misty
Reply With Quote
  #5  
Old 04-04-2005, 09:42 PM
Poncho Poncho is offline
Senior Member
 
Join Date: Oct 2004
Posts: 422
Default

Misty,

If you get "approval" for ADR make sure you write down who you talked to from BCBS and get what they call an "authorization number" and/or "precertification number" prior to getting surgery. This could be your saving grace if afterward they try to deny your claim.
(Common with BCBS)- Also, have a letter sent to them from your surgeon stateside called a "Letter of Medical Necessity" - prior to surgery is also more wood to add to your fire just in case if they try to deny coverage.

As you can see by my signature, I had Dr. Bertagnoli perform my ADR surgery abroad and doing well. I wish nothing but the best for you and your husband.
__________________
Sincerely,
Poncho (aka Prodisc Poster Girl)
2 level ADR (Prodisc)
Dr. Bertagnoli May 22, 2004 Rudolfinerhaus Vienna, Austria.
Currently DRUG FREE and living life again!
Knowledge is Power!!!
Reply With Quote
  #6  
Old 04-04-2005, 10:28 PM
ans ans is offline
Senior Member
 
Join Date: Mar 2005
Posts: 1,596
Default

Re: "Of all the ADR doctors I interviewed here and abroad, only Dr. John Regan was very truthful and honest about his ADR errors."

Very interesting.

Best of luck in this tough decision.

Allan
__________________
Severe, extensive DDD, considered inoperable by Dr. Regan, Lauressen, & some guy at UCLA. Severe foraminal stenosis (guess they can't operate!) and some spinal cord compression that Lauryssen would fix if gets outta hand.
Reply With Quote
  #7  
Old 04-04-2005, 11:34 PM
misty misty is offline
Junior Member
 
Join Date: Mar 2005
Posts: 7
Default

Poncho,

I have the Standard Federal Blue Cross Blue Shield program and they keep telling me that it's different than regular BCBS. In the BCBS Service Benefit Plan for federal employees, it says under section 5(i) Services, drugs and supplies provided overseas: "Please note that the requirements to obtain precertification for inpatient care and prior approval for those services listed in Section 3 (covered services and providers) do not apply when you receive care outside the United States." It also states that with overseas providers "We pay overseas claims at Preferred Benefits Levels, using an Overseas Fee Schedule as our plan allowance. Most overseas professional providers are under no obligation to accept our allowance, and you must pay any difference between our payment and the provider's bill. For facility care you receive overseas, we provide benefits in full after you pay the applicable copayment or coinsurance and and deductible that may apply."

When I called federal BCBS they said that they did have contracts with some of the doctors in Europe, so you wouldn't have to pay the amount above and what's "usual and customary", the provider would just write off the extra fees. I haven't bothered to get that list yet, but if I do I will post it.

Thanks for your help though. Hopefully somebody will give me a case number somewhere along the line! Take care, Misty

So, in a nut shell, they won't give me a case number! I'm not sure what to do about it either. It sounds like my coverage will be good, but I'm sure that whoever I go see is going to want a case number too. Insurance makes me crazy
Reply With Quote
Reply

Bookmarks

Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off


Similar Threads
Thread Thread Starter Forum Replies Last Post
Blue Cross Blue Shield ADR Denial finally reversed ZorroSF Insurance Hell 17 01-30-2014 06:46 PM
Blue Cross Blue Shield {aka Blue Crap} chasswen Insurance Hell 16 06-06-2012 05:03 PM
Blue Cross Blue Shield ADR Coverage stuschulz Insurance Hell 10 09-24-2007 09:54 AM
Technology Evaluation Center Blue Cross Blue Shield Abbe Insurance Hell 2 07-03-2007 07:30 PM
3rd Appeal with Blue Cross Blue Shield cavalier The Big File 10 03-25-2005 10:24 AM


All times are GMT -4. The time now is 02:36 PM.


© Copyright 2006-2017 ADRSupport.org All rights reserved.