ADRSupport Community  

Go Back   ADRSupport Community > General Discussion > Insurance Hell

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.


Reply
 
Thread Tools
  #1  
Old 07-25-2014, 06:33 PM
atxmom atxmom is offline
Junior Member
 
Join Date: Jul 2014
Posts: 11
Default BlueCard WW

I am not sure where to post this, in the international topic or here.

I have BCBS tx so I have Bluecard WW coverage as well. I am looking into the possibility of having surgery in Europe under this coverage as an alternative.

I see that several people have used Dr. Clavel, Stenum (and a few others in Germany). I wanted to find any other links to possible international facilities. Specifically any places in France that I can look into. I have not been able to find any medical tourism drs in France online.

Most of the places require payment upfront and it doesn't appear that there is any guarantee of coverage from BlueCard. I see that some people have had success with reimbursement, but others have been denied. I have family in Paris and also Besanson near Switzerland that I can stay with as long as needed. I wanted to see if there was any possibility of being able to per-authorization of coverage for my surgery.

I cannot afford to pay for ADR out of pocket, if anyone has had any experience with using their insurance internationally please let me know.
__________________
C3-4 5mm protrusion; cord contact
C4-5 3mm protrusion; cord contact
C5-6 3mm protrusion; Retrolisthesis 3mm; cord contact
C6-7 2mm protrusion; no cord contact

Waiting for 1st surgery
Reply With Quote
  #2  
Old 07-26-2014, 03:50 PM
henry4956's Avatar
henry4956 henry4956 is offline
Senior Member
 
Join Date: Oct 2013
Posts: 250
Default

I have BCBS RI, and BlueCard and for a while it seemed like I was going to get reimbursed. They contacted me after I had sent them all the wiring/invoice docs about a specific invoice that was not legible. Since then nothing except $140 for PT. I knew nothing about BlueCard until a few days before my surgery, so it's not like I was expecting anything all along. I talked to an agent last week who told me that all I need is a letter from Dr Zeegers stating that my surgery was necessary and that he pre-authorized it. She said he could pre date it. We'll see. I sent a draft to Dr Zeegers Thursday, he said he will fill it out and sign. Not optimistic that this will have any impact at all
__________________
Bad fall on A$$, Feb 2001 ice hockey
Lami L4/L5 April 2001, L5/S1 Aug 2001
Severe dislocated coccyx (same fall)
Un-diagnosed til 09. (Cannot sit)
Low back pain mild until 2011 - pull started a generator from knees.
rhizotomy Nov 2011 - zilch
Facet joint inj. 18 mo. (no impact)
Can only stand/walk for approx. 30 min
21 hrs/day in bed
L3-5 Activ-Ls (April 2014) Dr Zeegers - walk every day, swim 3 x week. Pain free, no pain meds. Extremely pleased with my decision
Reply With Quote
  #3  
Old 07-26-2014, 04:42 PM
NJ Gene NJ Gene is offline
Senior Member
 
Join Date: Feb 2013
Posts: 376
Default

Dear ATX,

Here's one thing to think about. ADR most likely won't be covered overseas. However, you can take it as a deduction on your tax return, to the extent it exceeds 10% of your adjusted gross income. This includes almost every aspect of your trip from travel for you and a companion, lodging, etc. The only thing not included would be meals for your companion. Also by doing this, any medical expense that your incur at home that same year which isn't covered by insurance (i.e. deductibles, doctor copays, drug copays, cosmetic surgery for you, your husband, and children assuming you file a joint return.) can be added to that amount. Effectively this could cover 1/3 of your total costs by paying less taxes or getting a larger refund. However, it will not reduce your tax to below zero. Hypothetically if your combined income with your husband is $50,000 and this whole thing with travel costs $60,000 (after the 10% threshold), you can only get back what's withheld from your pay in taxes. Since Texas has no income tax, you would only benefit by the reduction in Federal taxes. However, it is something to consider.

On another note, if you're considering going overseas, you're better off contacting the surgeons you're interested in directly as opposed to going through Medical Tourism. You'll get much quicker responses. Here is Dr. Clavel's website: Barcelona Spine Center DR Bierstedt's site is:ONZ Spine Surgeon for Disk Replacement, German Spine Specialists – M6 ADR Artificial Disk Replacement - Stop spine pain now, Lumbar Cervical Spine Surgery Finally Mr. Dare in Southampton, UK is Mr Christopher John Dare Orthopaedic surgery Consultant, Southampton, Hampshire, private hospital specialist.

Regards,
Gene
__________________
Car Accident 2002 - Small Herniated Disc C3/C4
1998 Larger Herniation and Cervical Fusion C3/C4
2005 Herniation C4/C5 - 40 epidural steroid injections from Oct 2005, - Oct, 2007
2008 - Foraminotomy at C6/C7 on left side
Feb, 2010 - Cervical Fusion C4/C5
Dec, 2010 - Lumbar Fusion L3/L5
2013 - Bulge on C5/C6; herniation C6/C7 right side
Mar 26, 2013 - Foraminotomy at C6/C7 on right side
May 5, 2015 - ADR with Dr Blumenthal of TBI for C5/C6 using Mobi-C
Reply With Quote
  #4  
Old 07-26-2014, 07:57 PM
atxmom atxmom is offline
Junior Member
 
Join Date: Jul 2014
Posts: 11
Default

That you for the contacts. I had already sent my info to Dr. Clavel and Dr. B in Germany, but I will try the UK as well. I'm not sure if I could afford them, but I can hope. I also saw on another site that another mom from my area had a surgery with Dr. Dam-Huei in Brest, France. She was also a three level candidate and a patient at TBI. Dr. Ziegler told her that best option was to try to go to France because fusion was not a good option for her age. Her diagnosis was also similar to mine.

The tax option would be good, except I am single now and haven't been able to work really. So no income to really deduct from. I am going to contact manufacturers of Mobi-C and try to get some surgeon names in France and see. I don't know exactly how Bluecardworldwide works. I downloaded the app but it I have to search for providers by city which has been time consuming.

I thought I could give that route a try because with my family overseas I could cut some of the expenses. I won't need a companion or housing. Bluecard seems hit or miss with reimbursement though.
__________________
C3-4 5mm protrusion; cord contact
C4-5 3mm protrusion; cord contact
C5-6 3mm protrusion; Retrolisthesis 3mm; cord contact
C6-7 2mm protrusion; no cord contact

Waiting for 1st surgery
Reply With Quote
  #5  
Old 07-29-2014, 11:41 AM
Throttlejockey Throttlejockey is offline
Member
 
Join Date: Jun 2014
Posts: 52
Default

I confirmed that we also have BlueCard Worldwide. If anyone is on this board has been successful with BCBSWW on a 2-level Cervial ADR please PM me. I am trying to learn what the "special sauce" might be.
__________________
- Wife has been diagnosed with Severe Spinal Stenosis Right and Left Sides, Degenerative Disk Disease at C5/6 and C6/7, Large Osteophyte Complexes at a both levels, with C6/7 on R/H Side, and C5/6 both R/H and L/H Sides. Also Reverse Lordosis.
- Performed 2-Level ADR with M6-C by Dr. Clavel, Barcelona Spine Center on 10/15/14.
Reply With Quote
  #6  
Old 08-19-2014, 08:26 PM
AWink AWink is offline
Junior Member
 
Join Date: Jul 2014
Posts: 1
Wink Also from Texas and getting 2 level from Dr Clavel

TEX,

I have two level (L3-L4 and L4- L5 (L3=Torn , L4 Bulging)) that needs to be replaced. I am going with Dr Clavel. He is not a bulk ADR doctor that does 2000 of them in a year like some of the docs in Germany.Very excited about finally having no pain. I also have BCBS of Texas. I am hoping that I get at least one level covered by insurance, if not, I am getting a medical loan from a family member. I can pay $500 a month for 10 years and be done with no more pain. But, I would def like to get insurance covered and get a damn boat or new car with that money!!

Does anyone have steps to take before surgery for what i need to collect for insurance? Do i contact insurance company before hand? I am scheduled for surgery October 9th. I have had 2 MRI's, Discography, 4 X-rays, 5 Cent injections, only 4 weeks of PT (Do I need 6?), and chiropractor for over a year. Also been seeing a pain management guy for close to 2 years. Consulted a US Surgeon (Wanted to do Fusion or ProDisk for 100k).

AW of Fort Worth
Reply With Quote
  #7  
Old 08-19-2014, 11:00 PM
JEVE19 JEVE19 is offline
Senior Member
 
Join Date: Feb 2006
Posts: 359
Default BCBS Worldwide

I called BCBS worldwide and asked them if I had coverage for an overseas surgery.
He asked me for my member number. Checked it and said yes, I have benefits.
He opened a case file for me and told me to call back when I had a surgery date.
He said the clinic had to get a pre authorization.
That's as far as I've gotten.
__________________
L5-S1 Lumbar M6 by Nick Boeree
10-14-2011
Reply With Quote
  #8  
Old 08-20-2014, 02:38 PM
henry4956's Avatar
henry4956 henry4956 is offline
Senior Member
 
Join Date: Oct 2013
Posts: 250
Default

I've talked to JasonHHH (I think that's his name) on this site. He doesn't post much. I did everything exactly like he did, I'm still waiting.

Concerning the Pre-Auth. Very debatable as to whether you should or should not. Jason did not and got 100% and I tend to agree. My reasoning is this: The one thing I keep hearing overtones about is 'Emergency' vs 'Planned' I think Pre-Auth proves planning. Again, no one seems to have the blueprint on this. I think if they deem that the surgery was planned then it decreases your chance for reimbursement. Obviously we all have to plan this but... I really think it's a hit or miss proposition - no rhyme or reason
__________________
Bad fall on A$$, Feb 2001 ice hockey
Lami L4/L5 April 2001, L5/S1 Aug 2001
Severe dislocated coccyx (same fall)
Un-diagnosed til 09. (Cannot sit)
Low back pain mild until 2011 - pull started a generator from knees.
rhizotomy Nov 2011 - zilch
Facet joint inj. 18 mo. (no impact)
Can only stand/walk for approx. 30 min
21 hrs/day in bed
L3-5 Activ-Ls (April 2014) Dr Zeegers - walk every day, swim 3 x week. Pain free, no pain meds. Extremely pleased with my decision
Reply With Quote
  #9  
Old 08-20-2014, 07:47 PM
Jerry5 Jerry5 is offline
Senior Member
 
Join Date: May 2013
Posts: 363
Default Bcww

Vicki, others,

I have the Blue insurance, and applied for Pre-Auth, denied, for M6, appealed, denied again, I paid, and just sent in the reimbursement, two weeks ago yesterday, will see.
(I ended up with an PLIF at the L51 level, so far not bad, little weak, but can walk a 'slow' mile on the treadmill)

If you have a procedure, that is covered here, they may cover this overseas.

Good Luck.
__________________
Jerry, Somewhere Ohio

L2-3 herniation, two days before Thanksgiving, 2012, Discectomy/Laminectomy, 3/13 Numbness in the right leg, lateral femoral, gone, July 10, 2014 L45 M6 ADR, July 15 PLIF L5-S1, Not able to access L51 Anterior.
Reply With Quote
  #10  
Old 08-21-2014, 10:44 AM
henry4956's Avatar
henry4956 henry4956 is offline
Senior Member
 
Join Date: Oct 2013
Posts: 250
Default 1st denial

I have my 1st official denial. BCWW does all the fact checking and validates all international records then they passed it on to my local BCBS of RI and it was denied by them, they said:
it did not meet the medical necessity for the type of service rendered. Unlike other insurance carriers who seem to focus on the whole 'Experimental' thing BCWW seems to be hung up on medical necessity and I really think their definition of medical necessity is tied to 'emergency' vs 'planned' procedure.

Round 1: BCWW
Round 2: just beginning
__________________
Bad fall on A$$, Feb 2001 ice hockey
Lami L4/L5 April 2001, L5/S1 Aug 2001
Severe dislocated coccyx (same fall)
Un-diagnosed til 09. (Cannot sit)
Low back pain mild until 2011 - pull started a generator from knees.
rhizotomy Nov 2011 - zilch
Facet joint inj. 18 mo. (no impact)
Can only stand/walk for approx. 30 min
21 hrs/day in bed
L3-5 Activ-Ls (April 2014) Dr Zeegers - walk every day, swim 3 x week. Pain free, no pain meds. Extremely pleased with my decision
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
Attempt at Direct billing by BlueCard WorldWide bwink23 Insurance Hell 8 04-08-2014 08:36 PM


All times are GMT -4. The time now is 06:30 AM.


© Copyright 2006-2017 ADRSupport.org All rights reserved.