Getting your insurance to pay

[Alastair]

Well I don't live in the USA, but from what I'm reading on these pages it looks as if USA citizen's are getting a hard deal both from the surgeons and from the insurance companies. The insurance companies look as if they do not want to spend the proper amount of money in giving extra days in hospital and follow-up for ADR treatment,and it looks as if the surgeons are having to go along with that because that's the only way they're going to get paid. It would seem also that there is a lot of lack of knowledge about aftercare because it's a new procedure.

From what I can gather ADR has been approved so I don't know why the insurance companies are declining proper care for their policyholders.

I would think that the way ahead for this is to go public in the press, those of you that are attending the New York symposium which Mark is running surely can get some quotes from the "World's Leading Spine Specialists" and push that at the press.

I don't know how you do the publicity thing in the USA but there's enough brains between the lot of you to sort something out. A lot of people have done a lot of begging to the insurance companies -- -- -- somehow you've got to get what you deserve and not what they would like to give you -- -- -- you have been given the knowledge and expertise on this board, I would ask the right questions at the right place at the right time and have the press present.
Best,
Alastair

[ans]

Maybe it would help the "cause" by inviting NYC TV /NYT/NY Post print reporters to cover the event. It's unique enough to pique interest.

Well-designed longitudinal studies are scarce in the literature and one European retrospective is damning but poor in research design/interp. (I think). At least insurers know with good long-term statisical confidence that fusion can really suck in the long-term. Go figure.

[letteski]

Alastair,
After reading a post from you re: post hospital care I called and asked to speak to my case manager. She said that my doctor only asked for one day and that is what I got with my authorization. I told her that what I know people are requiring 2-5 days. She said it is her job to call the hospital to see how I am doing and if I need more time she will authorize it. It has to do with the drugs I need for pain. She said, Hospitalization is not an excuse for a poor support team when you get out. It is up to the doctors not the insurance company as to how long you stay in the hospital in US the insurance companies keep a close eye on what is going on. Are the Doctors on your side of this issue or on the side of the insurance companys? To me that is the real question.

[Patrick]

The insurance companies don't want to pay for extra days in the hospital and post op care? Heck, most all of us can't even get the surgery approved. These other details are not even an issue at this point.

[biffnoble]

Well coverage in theory.

When Drs. don't request cash up front for multiple level lumbar procedures, that will signify coverage in a meaningful fashion.

[bmills]

I agree with Patrick.

I'm not worried about extra days in hospital care after surgery. Most likely, a long hospital stay would not be needed.

I would just like to get the benefits of getting the procedure I need after paying all these year's for my insurance and my family's insurance.

Brady

[Justin]

Most likely, a long hospital stay would not be needed.

Brady,

I was in the hospital for ten days and I was really thankful that I was in the hospital that long. I am young and fit, and I personally wouldn't have been able / comfortable leaving the hospital after 3 days. I appreciated the longer stay in the hospital--a 2-level is a big procedure and a 3-level is no walk in the park.

Justin

[letteski]

We need to remember that we are all at different stages in our ADR research and posses, some father along than others. Through these postings I am learning to be more proactive with this posses. I also feel it is important to have a specialist that is aware of the ADR complications and what to look for. My doctor that authorized one day in the hospital has no ADR under his belt. This info has come from the training he received in Nov'O4. So what are the US doctors learning about post op needs for ADR patients? FYI he will not be doing my ADR!

[ans]

I'm so paranoid that I'd prefer a longer vs. shorter stay b/c of DVT's. Never figured out how anyone can sleep in a hospital.

[AuntSueNY]

I am new to this site. I am in the Long Island New York area, and have Oxford Freedom select plan. I have DDD L5-S1 & DDD L4-L5 and am a candidate for ADR.

I have already been denied by Oxford "not medically necessary"

I went through the 1st level appeal process, same thing denied by Oxford "not medically necessary"

I went through the send level appeal process, same thing denied, "not medically necessary".

Went through the Greivance review board, same thing denied.

Then finally, Had to go through an External level appeal process, throught the State Insurance Department, they ultimatley came back and"DENIED" "not medically necessary".

I have also written the local news station, and currently waiting for a reply. I am at my wits end. I am willing to go as far as changing Insurance Companies. I have heard that Aetna (do not know which plan) is covering this ADR. If anyone has any information please let me know.

Thank you

Sue

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DDD L5-S1
DDD L4-L5
3 levels of appeals "denied"
external level appeals "denied"