ADRSupport Community  

Go Back   ADRSupport Community > General Discussion > The Big File

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.


Reply
 
Thread Tools
  #11  
Old 04-28-2005, 02:03 AM
Still Standing Still Standing is offline
Junior Member
 
Join Date: Apr 2005
Posts: 26
Default

Stan,
Based on my own interpretation of #3, I interpret it to mean that you would be denied coverage if your treatment was the subject of a research study. I think you would have to be a part of the study directly, or at the very least, your treatment facility would have to be conducting a research study involving a written protocol to which you are subjected. And I think your treatment would only be subjected to that written protocol if you were a subject participating in the research project. I don't think they can use a broad statement like #3 to include any treatment that is a part of any study anywhere. You should fully expect that there should be on-going studies evaluating any treatment-how else will the field of spinal surgery move forward? It is crucial to the evolution of the field of spinal surgery (or any field) to have on-going research and evaluation of the effectiveness of any treatment. That's my interpretation of the wording, for what it's worth.

By the way, I fit the FDA criteria, but ins. still denied my ADR anyway. I think they just automatically say NO. Reminds me of the Capital One commercial where David Spade is trainging the new guy that the answer is always no to any caller trying to redeem their credit card miles. The insurance company's answer is always NO! Hope your insurance company is different.
__________________
Still Standing
Annular tears L4-S1
06/05 Charite L4/5
) )
Reply With Quote
  #12  
Old 04-28-2005, 07:14 AM
Guest
 
Posts: n/a
Default

A good way to bully insurance co. to pay is to ask them directly who personally is denying your FDA approved surgery, and don't stop until you get some names. Ask them if you are approved for fusion surgery? Then inform them that if you are forced into fusion because of their refusal to pay for this approved procedure, you would be left with no recourse to hold them corporately and personally liable for any pain and suffering when it leads to future disc problems at other levels. You will be suprised how things change when you break down the faceless ins. companies to actual people.

Good luck

Pat
Reply With Quote
  #13  
Old 04-28-2005, 12:11 PM
sfmcfar sfmcfar is offline
Member
 
Join Date: Apr 2005
Posts: 61
Default

Hi,

In answer to Brady's question as to where I am in the authorization process is: I don't know. I *think* that my pre-authorization package is still being composed and has not yet been sent to MAMSI.
__________________
Stan
L5-S1 DDD and herniation
Reply With Quote
  #14  
Old 04-28-2005, 12:16 PM
sfmcfar sfmcfar is offline
Member
 
Join Date: Apr 2005
Posts: 61
Default

Forgot to mention that my original question has become somewhat moot. Since I'm covered under the Federal Employee Health Benefits (FEHB) Plan, my insurance carrier, by law, cannot declare anything that's FDA approved as experimental or investigational. They can still try the "not medically necessary" nonsense but they can't use the "experimental and investigational" label.
__________________
Stan
L5-S1 DDD and herniation
Reply With Quote
  #15  
Old 04-28-2005, 04:44 PM
Still Standing Still Standing is offline
Junior Member
 
Join Date: Apr 2005
Posts: 26
Default

Stan,
I would advise you to call your doctor's office to find out if (or when) they have sent the preautorization request in. I have had doctors tell me they were submitting it to the insurance company by the end of the week, and then sit on it for a month before sending it. They get busy, and sometimes a few phone calls can help give them a little push to file those papers. Often insurance companies have deadlines to rule on preauthorization requests. For example, my ins. company has 72 hours from the time they recieve a request in the preauthorization department to approve or deny a service. You might check if yours does. It sure beats anxiously awaiting the mailman day after day.
__________________
Still Standing
Annular tears L4-S1
06/05 Charite L4/5
) )
Reply With Quote
  #16  
Old 05-06-2005, 11:30 PM
Dave Dave is offline
Junior Member
 
Join Date: Mar 2005
Posts: 10
Default

Pat,

Great idea. Insurance companies may claim they don't have future liability for the directions they steer you, but in a case so stark, that seems pretty weak. Another point is that if ADR goes wrong, (which is no more likely that fusion going "wrong"), there are still options to correct it. Fusion is final, and irreversible. Furthermore, the question raised by future problems at other levels is, "Shall I have that fused too, and the next level, and the next?".

What seems like a better deal, for the insurance companies, and for the patients: A procedure that is final and likely to bring about one or more repeats of the same, or one of similar cost that can possibly be repaired, and that is less likely to need repeating at another level? I can't believe this debate is even happening.

Good luck to all.

Dave
Reply With Quote
Reply

Bookmarks

Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off


Similar Threads
Thread Thread Starter Forum Replies Last Post
FDA post-market surveillance and "experimental/investigational" sahuaro Insurance Hell 4 05-09-2008 07:01 AM
Liberty Mutual Workers Comp Says Prodisc Is Experimental Eddie_G The Big File 23 09-30-2006 01:59 PM


All times are GMT -4. The time now is 07:47 AM.


© Copyright 2006-2023 ADRSupport.org All rights reserved.