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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
05-17-2010, 10:51 AM
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Can anyone tell me the difference in price for an ADR and Fusion?
BCBS will not cover my ADR, so I'm wondering how much a fusion costs? Maybe I could pay the difference and of course talk the insurance into doing it?
I know Staci on here has gotten BCBS to cover her ADR (cervicial) mine is lumbar. I saw somewhere on here that Harrison fought BCBS and won. I want to fight for coverage if it can be done pretty quickly, as I NEED this ADR or fusion this summer. I am in too much pain!
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39yr old Dealing with back pain 3yrs now Been through 6 facet injections 3 Epidural injections Discogram (If U R thinking about a discogram PLEASE RESEARCH, In my case it helped but it is very, very, painful and in most cases its not needed) 2 "tears" in disc at L3-L4 (leaking fluid onto nerves) July 27, 2010 got Nuvasive XLTDR 
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#2
05-17-2010, 12:14 PM
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Rejecting coverage is not a matter of cost (so they say)
BCBS (who also rejected covering my ADR surgery and MANY others as well) does not refuse to cover ADR surgery because of the cost---it could cost less than fusion and they will still refuse to cover it! It is because they consider it "experimental and unproven" as it has not been done nearly as long as fusion. Most of us consider that an excuse to avoid paying, but that is their justification---it is not about cost compared to a fusion. You can try an appeal, a precious few have won against BCBS but most of us have lost. However, it will definitely not be a quick process---the few that have won have gone through multiple appeals and that has taken a year or more. If you need something quickly, appealing their rejection of your ADR is not the route to go. You would have to get the fusion (they covered 100% of my XLIF procedure, which was just as costly an as ADR surgery) or pay for ADR out of your pocket (probably overseas to save money).
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Charles B. Fainberg Back pain suddenly started 9/05, no injury or cause PT, Chiropractic, Epidural Injections - no help DDD confirmed via discogram at L4/L5 & L5/S1 (with issues at L3/L4 but no concordant pain) 3/06 Failed SED (Laser Endoscopic surgery) 4/06 2 level ADR (L4-L5 & L5-S1) with Maverick disc at Stenum 8/06 XLIF Fusion (L3/L4) 9/08
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#3
05-17-2010, 12:29 PM
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Thanks for your response. Yeah, I don't have time to fight it if it will take a year. And I don't want to go into debt. So I'm leaning more toward the fusion at this point.
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39yr old Dealing with back pain 3yrs now Been through 6 facet injections 3 Epidural injections Discogram (If U R thinking about a discogram PLEASE RESEARCH, In my case it helped but it is very, very, painful and in most cases its not needed) 2 "tears" in disc at L3-L4 (leaking fluid onto nerves) July 27, 2010 got Nuvasive XLTDR
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