Aetna just paid 100% for my 2 level adr at Stenum

[gjmorse]

Aetna just paid 100% for my 2 level adr at Stenum

I had Aetna with out of network coverage. I had to pre-pay Stenum out of my pocket.

Included in my submission to Aetna were the following;
1. Included the surgery detailed bill from Stenum.

2. I then added a cover letter with the complete history of my back, including the different treatment options that i could have done instead of ADR.

3. I also included the x-rays from Stenum.

4. I also included the email correspondance from Stenum with the surgeons.

5. I also included my Bank of America Money transfers to Stenum.

Then I submitted this large package to Aetna. Starting a month after submission I called them every week.

In the end Aetna paid 100% and even late interest. I am very happy with them.

[Harrison]

That's another milestone! Blue Cross Blue Shield has paid for a two level at Stenum as well...

[trkdoc714]

That's great news! How long did it take you from when you first filed the claim until they sent you the reimbursement?

I'll bet that's a load of pressure off of your shoulders.....and new discs

Congratulations!

Bob

[Robert G]

I would like to look at the terms of coverage and compare it to mine. I just need the plan name, I think the brochures are online?

Thanks,

[trkdoc714]

Gary,

I just started the precertification process with Aetna. No precertification needed but they have a clinical bulletin (#0591) restricting coverage to FDA approved devices e.g. Charite or ProDisc. How did you get that one past the goalie?

I think that's the only hurdle I have left before I can be comfortable about being reimbursed by Aetna for the Maverick disc. Otherwise I'll have to sell one of the kids or borrow money from Rocco's Scrapyard and Loan Company. I'd bet I could get in trouble for either one of those options.

Thanks for your help,

Bob

[tkdodger]

Originally Posted by Harrison

That's another milestone! Blue Cross Blue Shield has paid for a two level at Stenum as well...

Can you give me more info? Which of the BC BS entities approved a 2 level ADR at Stenum? I am considering that very thing!

[Jmbeam]

Harrison

Can you please reply back to the previous question? I can bet that many people are hanging on your answer.

[Harrison]

Folks, I am only reporting on what patients in these forums have posted. Sorry I can't address many (or most) of the insurance questions. There's enough questions on insurance to keep five Harrisons busy all week!

[gil]

gjmorse,
This may make sense to Aetna since Germany surgery costs less than US. So you ended up paying for your travel and lodging expense? Could you tell me what Aetna plan you have? - I have an Open Acess HMO.

thanks,
gil

[MMsC5-6-7]

gjmorse,

I'm new to this forum so not sure how to check, but I hope you're still posting your progress on this site?!

I have just sent my records to Dr. Bierstedt in Germany to see if I'm a candidate for 2-level ADR. I also have Aetna insurance (Aetna International), and if I am a candidate for the surgery, it would be very helpful if I could provide them with information on your approval to help my case. Would this be possible?

Also curious to see how you're doing? If anyone has more information about Aetna approvals that would help move my approval process along I would be grateful.

Wishing all the fellow spine travelers here the best of health and healing!

Melissa