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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  
Old 03-11-2009, 12:03 PM
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Harrison Harrison is offline
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Exclamation Archiving of Successful Appeals

Hi everyone,

It’s taken me some time, but I am now ready to receive, categorize and securely archive any and all insurance appeals from spine patients. BTW: out of state appeals will not usually help individual patients.

Going forward, please email, private message or fax me evidence of insurance payment. This may include: approval letters, reimbursement receipts, and other documentation.

All of your personal information (especially social security information) should be crossed out before you send it to me. I’ll also review it to ensure anonymity.

Providing this free service to you all should eliminate some of your extra legwork and hopefully help you win your appeals.

: )
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"Harrison" - info (at) adrsupport.org
Fell on my ***winter 2003, Canceled fusion April 6 2004
Reborn June 25th, 2004, L5-S1 ADR Charite in Boston
Founder & moderator of ADRSupport - 2004
Founder Arthroplasty Patient Foundation a 501(c)(3) - 2006
Creator & producer, Why Am I Still Sick? - 2012
Donate www.arthropatient.org/about/donate
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  #2  
Old 04-10-2009, 07:49 PM
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Harrison Harrison is offline
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Default Refreshing This Topic

Hi everyone,

I get request from patients several times weekly for information on successful appeals. PLEASE send me any documentation you have on your successful appeal! It can and will help many people!

I'll send out an email soon too all members with the same request. Thank you!
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"Harrison" - info (at) adrsupport.org
Fell on my ***winter 2003, Canceled fusion April 6 2004
Reborn June 25th, 2004, L5-S1 ADR Charite in Boston
Founder & moderator of ADRSupport - 2004
Founder Arthroplasty Patient Foundation a 501(c)(3) - 2006
Creator & producer, Why Am I Still Sick? - 2012
Donate www.arthropatient.org/about/donate
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  #3  
Old 08-31-2009, 01:34 AM
ans ans is offline
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Default

Yes, please help and share.

Allan
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Severe, extensive DDD, considered inoperable by Dr. Regan, Lauressen, & some guy at UCLA. Severe foraminal stenosis (guess they can't operate!) and some spinal cord compression that Lauryssen would fix if gets outta hand.
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  #4  
Old 02-02-2014, 03:43 PM
VegasGuy13 VegasGuy13 is offline
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Join Date: May 2013
Posts: 13
Default Information on successful appeals

Hi Harrison,

I am now having to appeal the surgeon portion of my ADR. I was paid for the surgery center. I would appreciate info on precedents for allowing cervical ADR from BCBS and other insurance companies. I am appealing to BCBS in California. I am a federal employee retired. Also any actual language used in the appeals especially regarding investigational and medical necessity issues. I will be glad to share my appeal with you when it is completed and especially if it is successful.
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  #5  
Old 02-11-2014, 12:06 PM
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MMsC5-6-7 MMsC5-6-7 is offline
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Default Any Aetna ADR approvals in the archives?

Harrison,

Do you have any Aetna approvals for ADR in your archives you could share? I will be sending Dr. Bierstedt's surgery recommendation, my MRI and CT reports and a letter to Aetna International requesting coverage. My only hope is because I have international coverage based outside the US, I might get lucky. Would be good to have some backup of previous approvals if available.

Thank you,
Melissa
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--------------
DEC 2013 MRI/CT scans show severe spondylosis at C5-C6/C6-C7; moderate at C4-C5
Spondylotic spurs C2 thru C7
Left vertebral artery medial loop at C4 body
Foot / hand numbness
Throat tightening and on/off lump sensation
Neck pain, upper back ache between shoulder blades
52 years on this planet (most of the time)
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Old 02-11-2014, 06:31 PM
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Harrison Harrison is offline
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Default

Sorry folks, I never built a private archive, everything has been posted. Search through this forum, or use the search button above...
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"Harrison" - info (at) adrsupport.org
Fell on my ***winter 2003, Canceled fusion April 6 2004
Reborn June 25th, 2004, L5-S1 ADR Charite in Boston
Founder & moderator of ADRSupport - 2004
Founder Arthroplasty Patient Foundation a 501(c)(3) - 2006
Creator & producer, Why Am I Still Sick? - 2012
Donate www.arthropatient.org/about/donate
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  #7  
Old 02-28-2014, 12:46 AM
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Kelly4ADR Kelly4ADR is offline
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Posts: 259
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Has no one replied to this thread with successful appeals?? I so much appreciate the support on this forum... Please post your approved appeals! I promise to do the same if mine gets approved! I have Aetna, just got denied for a cervical two level... Round one!
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2004 MRI -cervical bone spur causing pain
2011 MRI -5 bulging discs at C3-7: Recommended C5-6 and C6-7 for a two level fusion, I said no thanks.
2014 MRI -progressive compression C5-7.
MRI 6/5/14- Ruptured L4-5, bulge at L2-3 and L5-S1 Dr recommends discectomy of L4-5 but won't do surgery until cervical is stable
8/2014- 8 months/3 rounds of appeals, Aetna denies 2 level cervical ADR
2 level ADR w/ mobi-c C5-7 Jan 7, 2015
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