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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 04-26-2005, 04:01 PM
AuntSueNY AuntSueNY is offline
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Join Date: Apr 2005
Posts: 3
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I am new to this support group. I am on Long Island, New York and have Oxford Freedom Select. I have been denied, I went through the 1st, 2nd, appeals, Greivance Review Board, and a External Appeal Process. I have been denied by all of the above "not medically necessary".

I have also contacted the local news station awaiting reply.

I will go to any length including changing insurance companies.

I have heard that Aetna is covering this ADR, but need to find out which plan. If anyone knows of this information please let me know.

Thank you

Sue
-----

excuriating back pain
MRI, CAT SCAN, etc.
pain meds, muscle relaxers
cannot sit for any length of time
cannot stand for any length of time
lying down dosen't help
DDD L5-S1
DDD L4-L5
candidate for ADR
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  #2  
Old 04-26-2005, 05:26 PM
NCFUSED NCFUSED is offline
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Join Date: Jan 2005
Posts: 128
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Aetna's medical policy on Charite ADR 1 level

http://www.aetna.com/cpb/data/CPBA0591.html

Trying to change insurance companies could get you in the "Pre-existing Condition" bucket and they could deny you that way.....
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John
Greensboro, NC
DDD L5-S1
Lost all ADR Appeals w/ UHC PLIF Fusion L5-S1 on 5/17/05.
Pars Defect L3-L4
DDD L3-L4 L4-L5
3 LVL Fusion Scheduled 4/08
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  #3  
Old 04-26-2005, 11:27 PM
Kim Kim is offline
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Join Date: Apr 2005
Posts: 267
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Yes be very very very careful before changing insurance companies. Require in writing that they will not pre exist any conditions. Most plans will pre exist conditions and deny coverage for them for a period of 12 months after you start having coverage with them. Some pre exist forever on certain things.
There are plans who do not consider pre existing conditions. I do not know if Aetna is one of them. Ask question, lots of questions before doing this.
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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  #4  
Old 04-27-2005, 10:19 AM
APS APS is offline
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Join Date: Mar 2005
Posts: 53
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FYI - I just changed jobs and was told there would be no pre existing conditions because I didn't have a break in coverage going from one plan to the next. I had never heard this before so we'll see.
Andrea
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Andrea
Grand Junction/Denver, CO

Failed L4-5 diskectomies '93 & '00
ADR originally scheduled 3/9/05; dropped insurance appeal due to new job; new insurance UHC
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