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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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  #1  
Old 01-29-2007, 01:17 PM
LBP LBP is offline
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Join Date: Aug 2005
Posts: 446
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I would like to start a list of people who still have been denied ADR surgery by their insurance company.

What city do you reside, how many levels do you need, and who is your insurance company that denied you. Please specify if you are a workers compensation case because that is a whole different animal.

I am curious to know how many people with single levels still aren't being approved or are they only ones with trouble the ones with multiple levels?????


Anyone interested in posting your information?

Maybe it would be good to also include those that have paid out of pocket to go to Germany because they were denied by their insurance company.
re: lawsuit...highly unlikely in light of another thread discussing ERISA. Still good info to list what companies are not paying up!
__________________
Injured 9/01
Annular tears L4/5 & L5/S1
denied adr by insurance for 2 level charite as well as hybrid fusion at L5/S1 with Charite at L4/5.

New ins paid for 2 level lumbar prodisc surgery on 4/7/08 (at age 39) with Dr. Westerlund, at Core Orthop
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  #2  
Old 01-29-2007, 01:18 PM
LBP LBP is offline
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I'll start,

Need 2 levels, L4/5 and L5/S1. In 2005, was turned down by Pacificare/UHC PPO for 2 level Charite. Insurance was employer provided insurance from when I used to work in San Diego, CA. Later also denied for a combination Charite at L4/5/fusion L5/S1, same insurance via fed and state extended COBRA while living in Milwaukee, WI. Fusion was tentatively approved but not the Charite portion. Currently reside in Milwaukee, WI. Exhausted all appeals, including appeals with CA Dept of Ins.
__________________
Injured 9/01
Annular tears L4/5 & L5/S1
denied adr by insurance for 2 level charite as well as hybrid fusion at L5/S1 with Charite at L4/5.

New ins paid for 2 level lumbar prodisc surgery on 4/7/08 (at age 39) with Dr. Westerlund, at Core Orthop
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  #3  
Old 01-29-2007, 01:27 PM
chasswen chasswen is offline
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Join Date: Apr 2006
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me me me i was denied a single level adr charite blue crap.
chuck
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ddd 1990
2003 mri,xrays,shots,emg
2004 discogram ouch pos l4 l5
facet block neg
lost all appeals BCBS 5 months of that
3 surgeons later
surgery with dr. bertagnoli aug 2nd 2006 in Bogen Germany Successfully ProDisc-L L-4 L-5
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  #4  
Old 01-29-2007, 05:13 PM
JFerg JFerg is offline
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Join Date: Apr 2006
Posts: 52
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Put me down........denied 3X's United Health Care - 2 levels.
I support your right to petition. Let me know if I can help in any way.
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DDD diagnosis - denied disc replacement by United Health Care 3x's - Recently, Manipulation Under Anesthesia procedure - much needed relief from constant pain.
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  #5  
Old 01-29-2007, 08:31 PM
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Terry Terry is offline
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Blue Cross Michigan denied 2 level Charite discs done by a surgeon approved and on Harrison's list of Charite surgeons. I went to Germany and paid out-of-pocket for 4 level ADR.

I sued the homeowner's insurance and Blue Cross maintained a lien against the suit. In order to get rid of the lien I had to waive the right to appeal. Nifty.

Terry Newton
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1980 ruptured L4-L5
1988 ruptured SI-L5
1990 ruptured C5-C6
1994 ruptured C6-C7
1995 Hemi-Laminectomy C5-C6, C6-C7 Mayo Clinic
Bicycle Accident 2004
MRI, EMG, Facet Injections, Epidural Blocks, Lumbar Discogram.
Stenum Hospital Surgery November 4, 2006
Prestige Disc C5-C6, C6-C7
Maverick Disc S1-L5, L4-L5
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  #6  
Old 01-30-2007, 11:08 AM
Brad Brad is offline
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Join Date: Jan 2005
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Denied by Cigna PPO in California. went to Germany, now pain free and happy.
I hope the insurance geek that denied my coverage has a bad back......let him suffer.

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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  #7  
Old 01-30-2007, 08:58 PM
Nairek Nairek is offline
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Denied by Empire Blue Cross Blue Shield for a 1 level Charite ADR at L5-S1. Currently on my 2nd level appeal & keeping all fingers, toes, & eyelashes crossed that I will get the denial overturned!
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----Karin----
Disc Bulge C4/C5, Disc Degeneration T11/T12, Bi-Lateral tears L5/S1, Diagnosed w/ Lumbar Disc Derangement w/ Radiculopaphy. Treatment: IDET, Percutaneous Discectomy, SI Joint Injection, Facet Block. All failed. Empire BC/BS Denied Coverage for ADR-lost all of my appeals. MVP also denied coverage.

ALIF/PLIF Fusion 1/20/09
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  #8  
Old 01-31-2007, 07:47 AM
Texas-T Texas-T is offline
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I was denied a single level L5/S1 Charite from United Health Care.

I was later approved by Aetna when I switched insurance companies.
__________________
Tear L5/S1 (Pain generator)
IDET 2003 L5/S1 Failed
Shots, MRI's, PT, Drugs & All that Jazz
ADR L5/S1 May 17th 2006 w/Dr. Bitan
http://adrrecovery.blogspot.com/
Doing GREAT and feeling very lucky!
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  #9  
Old 02-01-2007, 10:07 AM
Kim Kim is offline
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Denied by Great West Healthcare for a 2 level lumbar ADR L5/S1 L4/L5
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Kim
Herniated disc L5/S1 2000 Discectomy 10/2003 Rhizotomy 8/2004 and 3/2005Discogram 11/04 grade 7 tear L5/S1
L4/L5 Grade 5 tear with herniation and stenosis
Evaluated by Dr Blumenthal at TBI
2/2005 ADR 2 level recommended
2 level lumbar fusion
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  #10  
Old 02-15-2007, 10:51 AM
Abbe Abbe is offline
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Join Date: Feb 2007
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I have been denied by Blue Cross Blue Shield of California. I am about to start the appeals process and am waiting to get a copy of Dr. Lytton William's letter so that we can be in sync. I did find that Prodisc has a place on their website for others in the appeals process and an 866-223-0508. There are Patient appeal letters and surgeon resources. Not sure if this will help my case or not but I am open to suggestions.
__________________
Water ski accident 86'
Chiropractic& PT Pain meds
Discectomy Laminectomy
L5 S1 Partially sacralized
97' epidural injections
L3 L4 ruptured and torn
L4 L5 Almost no disk height left along with osteophytes
Left leg pain and tingling going down back of leg into heel & foot
3 appeals with BCBS no success Lost insurance.
Kaiser Permanente
L3-L4, L4-L5 Prodisc 9/18/09
C5-6 & C6-7 ruptured and looking at hybrid surgery fusion & Prestige ADR
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