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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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  #1  
Old 07-16-2007, 09:35 PM
Ouch! Ouch! is offline
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To give you what I hope is a short summary...

After going back & forth between TBI and the insurance company, we are ultimately paying out of pocket. I pleaded with the lady in the billing dept at TBI to try to get her to have the pre-certification person refile with the insurance using codes the ins co says they cover. So far nothing new has been filed with insurance. The pre-cert lady is adamant that insurance won't cover adr so just pay out of pocket or cancel. The insurance denial letter did come today & used notes from Aug 2002 to say, it isn't covered. On the phone insurance co is saying use the codes we gave you! So this isn't going anywhere.

We are borrowing on the equity in our house to pay for surgery. But, hey, at least we have some equity.

My husband & I fly to Dallas in the morning. I see Dr Zigler for another appointment on Wednesday. First thing Thursday is surgery. At least with everything going on I haven't had time to dwell on things or get too nervous.

Please wish me luck. I am taking a computer, but don't know how much I will get to do on line before surgery.

I will definitely post after surgery when I feel better.

Jane
__________________
DDD L5/S1
No Fusion, please.
Looking for ADR direction
20 years of back problems, no known specific cause
5/9/07 at Consultation Texas Back Institute, Dr. Zigler
7/5/07 Insurance struggles
7/19/07 Prodisk surgery, TBI, Dr Zigler
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  #2  
Old 07-17-2007, 10:35 AM
Kim Kim is offline
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Jane I would get the info from the Ins company and what codes they want etc and when you get out to TX go yourself and talk to the billing person there.
I found TBI lacked a LOT in some of the office staff there and especially in the billing area of the office.
They are not keen to help ANYONE get coverage from what I have seen and heard and its up to you to get what you need to advocate for yourself.
This is one reason I went to Bitan to have my surgery rather than Blumenthal. They would give me no help atall to try to work on my appeals with the ins company when I was trying to get approval for ADR.
Good luck to you I Hope that you can get this resolved
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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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  #3  
Old 07-17-2007, 12:25 PM
chasswen chasswen is offline
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best of luck to you jane this thursday.
you will be in very good hands.
May The Force Be With You!!
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 07-17-2007, 01:25 PM
Can\'t_Sit Can\'t_Sit is offline
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Best of Luck!

You're in good hands at TBI. They do have wireless internet in the hospital, so you can browse the internet after your surgery.

Let us know how you are doing.

We'll "see you on the other side".
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Paula
37 years young
DDD, minor scoliosis 2003
L4/L5, L5/S1 herniated and bulging, Discogram confirmed
Three spinal nerve blocks, One SI joint nerve block, 8 wks of PT, pain/anti-inflammatory meds
L4/5, L5/S1 ProDisc ADR with Dr. Zigler at Texas
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  #5  
Old 07-18-2007, 11:17 AM
Lisibug Lisibug is offline
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Hope it goes really well for you and that you are quickly on the road to feeling much better.
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Lisa
Back/neck pain with chiropractic treatment 3 x week in 1973 (age 13) for 1 year and pain since then due to falling off horses
headaches since age 17
Onset of severe fibromyalgia in 6/95, undiagnosed for 2 years while lived in UK
About 1998 o
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  #6  
Old 07-18-2007, 12:15 PM
Justin Justin is offline
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Join Date: Oct 2004
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Good luck Jane! See you on the other side.

Justin
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  #7  
Old 07-18-2007, 10:12 PM
Ouch! Ouch! is offline
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Thanks to all for your good wishes.

I have to be at TBI before 6 am. YUCK! I am not a morning person, but I am very glad to be first on the OR schedule for tomorrow. Plus I understand Dr. Zigler is a morning person.

I saw Dr. Zigler again today. My husband met him and really liked him too. Dr. Zigler has said we will try for the prodisk, but no promises. If he can't get the disk in then he will fuse the area. He has explained everything very well.

I had my "training session" next. I am sure a lot of the stuff they cover is to protect them from liability, but I must say it was the most extensive coverage of everything about the surgery I have ever had for any surgery. Three power point programs and then a PA explains the whole surgery, step by step, shows you a disk, the different things they can use if you have a fusion, etc. She really was thorough.

Kim, I found your comments about the handling of insurance at TBI to be right on. I guess we should take care of the insurance problem before surgery but we have decided to fight that battle post-op. We have Tricare from the military and there are many things they won't cover. Right now Tricare is quoting coverage chapter dated August 2002, so it is probably a loosing battle anyway.

Kim, Did you get your adr covered by your insurance?

I will let you all know how I make out after tomorrow.

Thanks again for all your encouragement.

Jane
__________________
DDD L5/S1
No Fusion, please.
Looking for ADR direction
20 years of back problems, no known specific cause
5/9/07 at Consultation Texas Back Institute, Dr. Zigler
7/5/07 Insurance struggles
7/19/07 Prodisk surgery, TBI, Dr Zigler
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  #8  
Old 07-18-2007, 10:41 PM
ZorroSF ZorroSF is offline
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Posts: 303
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Quote:
Originally posted by Ouch!:
I pleaded with the lady in the billing dept at TBI to try to get her to have the pre-certification person refile with the insurance using codes the ins co says they cover.

makes you wonder how much of our pre-op and post-op stress, due to corporate beligerance and ignorance, contributes to our slow slow recoveries.

As for demonstrating evidence cited from 2002, it's the tactic by most insurance companies to consider anything experimental until 5 years of data has come through. looks like you have some ammo to throw at them since it's been 5 years according to them.
__________________
***********************
1/2006 DDD L5/S1

Prodisc St. Mary's 12/2006 not diagnosed properly pre-op and now have DDD L4/L5, facet calcification L5-S1/L4-L5, mild scoliosis and left knee pain. DDD: C3 through C6
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