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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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#11
03-07-2005, 10:08 AM
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Leanne, Lori & Mark - I am going for a in person appeal this coming THURS - my 3rd appeal with BCBS. I am being denied for saying experimental HOWEVER ONLY the device is classified as experimental the surgery itself is not experimental it is the same prep work as it would be for a fusion other than the device itself so my argument is pay for all but the device for me that was only 3k fo the 21,5 I paid for the whole surgery overseas.
Leanne if you would please e-ml me the documents you have that would be GREAT ! If you do a search for Charite & P.D. you will find the doc's doing this one is in Nashville & others in that area for P.D. & one is here in Memphis but he is done with the P.D. trial - Jill L4L5 ADR 7/6/04 
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#12
03-07-2005, 10:14 AM
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Leaane - My eml addy direct is catesbycavs@bellsouth.net As I posted above my in person appeal is this WEEK this THURS !
Any help is appreciated- Jill ( Memphis Tn)
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#13
04-09-2005, 07:10 AM
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Leanne,
I believe I could benefit from your information. I was denied L5-S1 ADR by bc/bs of western pa (highmark) for the exact same reason (investgative/experimental) I would be grateful for a copy of your final submission, sounds very similar to what I am up against. I am in Maryland but the insurer is in PA because I work for Erie insurance in Maryland but their home office is in PA and Bc/Bs administers their health coverage. I have also spoken with the Maryland Insurance commission and if I am denied my appeal they will then get involved and put it to their own review board. It is a very time consuming endevor and I can use all the help I can get. Thanks for whatever you can provide. my email address: Morehison1@adelphia.net
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#14
04-10-2005, 08:34 PM
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Leanne
If you could send me the info also I would really appreciate it. I have just gotten my first denial from Great West considering the ADR experimental blah blah blah like the other letters above. Any info you can give would be greatly appreciated. Email is kimleach@bellsouth.net I tried to PM you but it would not let me. Kim
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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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#15
04-11-2005, 09:06 PM
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Leanne :This 3 level candidate would gretly appreciate a copy also. I am just beginning my "discussions" BS/BC of Iowa .
welchtm@iowatelecom.net
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2005- large protruded disc and severe lumbar stenosis , 3level ADR/fusion candidate L3/4, L4/5 and L5/S1 Disectomy at L3-4 and L4-5 in 2002 Repeat at L3-4 in 2003 Also have Severe stenosis at C5/6 and C6/7- Cervical fusion recommended also.
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#16
04-11-2005, 10:35 PM
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Leanne, I would also like a copy of any thing that might help in my appeal. My email is mikencat1122@yahoo.com Thanks Cathy
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Lumbar pain after 2 MVA's Numerous blocks and epidur's 2 discograms IDET July 2003 L4/L5 & L5/S1.
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