Golden Rule coverage

[thunder75089]

Hey all,
My first post, despite a lot of reading. I thought this might be helpful. I was initially refused by my insurance company Golden Rule for a single level lumbar disc (pre-authorization). I was given a cash rate by the Texas Back Institute and paid for it. I had my L5-S1 replaced with a Charite in August 10'. After the surgery, TBI submitted it anyway. It was Paid in full after the insurance company reviewed it. They said it was no longer experimental. They are a "United healthcare company". TBI said they couldn't believe it. I don't have a letter from the insurance company, but I thought most would appreciate this information.
Larry
Charite L5-S1... New version

[Harrison]

Well, this is great news indeed! Perhaps you are a "golden boy," especially in light of the trend of most big insurance companies not only NOT paying for ADR, but now refusing fusions.

As you may know, I had ADR surgery in 2004 with the Charite' and thankfully, doing great: pain-free and active. However, I did have to appeal and fought BCBS for many months and eventually won everything except the co-payment for surgery ($500).

As you can seen from the article below, Blue Cross is living to its name: Blue Corpse Blue Sled.

Congrats! When you can, please post in the Surgical Outcomes forums. Take it slow!

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Blue Shield Rate Hikes To Proceed Despite Protests From Regulators

MARCUS WOHLSEN 01/14/11

SAN FRANCISCO — Blue Shield of California said Friday it was planning to go forward with scheduled health insurance rate increases for individual policyholders, despite calls from government regulators to delay the move.

The San Francisco-based insurer said that it has asked an independent actuary to review the increases and would issue refunds if problems were found with the rates.

California Insurance Commissioner Dave Jones had asked Blue Shield to delay planned increases on March 1 so his department could conduct a full review.

The insurer has implemented two rate hikes since Oct. 1. Some policyholders would pay 59 percent more in premiums cumulatively over the three increases.

Blue Shield CEO Bruce Bodaken said the increases were necessary because of rising health care costs.

"Our premiums are rising because of the rapid increase in health care expenses for our members," Bodaken said. "Reducing medical costs must be an urgent national priority for health coverage to be affordable for the vast majority of Americans."

In a statement, Blue Shield called its pledge to abide by the actuary's conclusions "unprecedented." Jones said the insurer was required by a state law that took effect at the beginning of the year to retain an independent actuary to evaluate any rate increase.

That law also required the insurance commissioner to review the reasonableness of rate hikes, but did not give him the authority to reject the increases.

"I do not have that authority now. I have been fighting to get that authority," Jones said.

Jones called the Blue Shield hikes unsustainable at a time when many Californians are struggling financially.

Blue Shield said it had hired David Axene as the actuary who would review its rates. Axene last year uncovered errors in rate increases proposed by Anthem Blue Cross that had come under fire from President Barack Obama during the debate over his health care reform bill.

The discovery lead Anthem to reduce its increases to an average of 14 percent from proposed rate hikes as high as 39 percent.

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Source article is at the Huffington Post here.

[JEVE19]

I have Golden Rule. Been battling them for three years.
Won't cover anything having to do with my back.

Golden Rule (I think their golden motto is pay for it but don't use it)!