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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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  #11  
Old 07-07-2008, 01:49 PM
LBP LBP is offline
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when you say "mandate" do you actually have a copy of the FEHB policy letter?

You can find it online. Us Office of Personnel Management, Office of Insurance Programs, FEHB Program Carrier Letter (All Carriers) Letter No. 2001-27. It's not a case by case policy. That was the whole point of making the policy. Carriers were being inconsistent in applying their own standards vs FDA standards of what is "experimental and investigational."

look up the "mandate" read the policy letter!

Being a federal employee, you have a stronger argument than most. There is a guy a long time ago that won this argument when his private insurer denied him, against Fed policy. He got is surgery. do a "find" for FEHB you'll probably find him.
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Injured 9/01
Annular tears L4/5 & L5/S1
denied adr by insurance for 2 level charite as well as hybrid fusion at L5/S1 with Charite at L4/5.

New ins paid for 2 level lumbar prodisc surgery on 4/7/08 (at age 39) with Dr. Westerlund, at Core Orthop
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  #12  
Old 07-20-2008, 06:27 PM
ans ans is offline
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I'd be more than grateful to see an approval letter from Anthem BC of CA and Empire BC/BS of NY. Puleeze!

ans

bicyclettes@yahoo.com
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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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  #13  
Old 07-20-2008, 06:36 PM
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Jmbeam Jmbeam is offline
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Hello,

I would appreciate a copy of this letter also. If anyone else on the board has any approvals from BC BS I would be greatly appreciative. Thanks Jim
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Hybrid surgery performed by Dr Clavel Nov. 2012
Adr- S1-L5 with M6
Fusion- L5-L4
Adr- L4-L3 with M6
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  #14  
Old 07-20-2008, 06:38 PM
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Jmbeam Jmbeam is offline
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Sorry you can send it to mygirls@twcny.rr.com
Thanks again
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Hybrid surgery performed by Dr Clavel Nov. 2012
Adr- S1-L5 with M6
Fusion- L5-L4
Adr- L4-L3 with M6
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  #15  
Old 07-28-2008, 01:39 PM
ans ans is offline
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I'm waiting!

The check w/be in the mail.
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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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  #16  
Old 07-28-2008, 02:03 PM
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Terry Terry is offline
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Quote:
Originally posted by Jmbeam:
Terry,

Where in the US did you have a 4 level adr performed? I had my films reviewed in Germany and require a 3 level ADR. However I dont have the required $50K+ to get it done. My wife has BCBS and I am also on Medicare via Social Security Disability. Do you think it is advantageous for me being on Medicare or would I have a better shot in getting Insurance approval if I only had BCBS? Thanks for any input you can provide.
WOW. I did not see this post and missed putting in a reply. I had went to Stenum Hospital in Germany for my 4 level ADR surgery. I am at 20 months following my surgery and life is good. I am sorry for the late response.

Terry Newton
__________________
1980 ruptured L4-L5
1988 ruptured SI-L5
1990 ruptured C5-C6
1994 ruptured C6-C7
1995 Hemi-Laminectomy C5-C6, C6-C7 Mayo Clinic
Bicycle Accident 2004
MRI, EMG, Facet Injections, Epidural Blocks, Lumbar Discogram.
Stenum Hospital Surgery November 4, 2006
Prestige Disc C5-C6, C6-C7
Maverick Disc S1-L5, L4-L5
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  #17  
Old 07-28-2008, 02:04 PM
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Terry Terry is offline
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Quote:
Originally posted by Terry:
<BLOCKQUOTE class="ip-ubbcode-quote"><div class="ip-ubbcode-quote-title">quote:</div><div class="ip-ubbcode-quote-content">Originally posted by Jmbeam:
Terry,

Where in the US did you have a 4 level adr performed? I had my films reviewed in Germany and require a 3 level ADR. However I dont have the required $50K+ to get it done. My wife has BCBS and I am also on Medicare via Social Security Disability. Do you think it is advantageous for me being on Medicare or would I have a better shot in getting Insurance approval if I only had BCBS? Thanks for any input you can provide.
WOW. I did not see this post and missed putting in a reply. I had went to Stenum Hospital in Germany for my 4 level ADR surgery. I am at 20 months following my surgery and life is good. I am sorry for the late response. I would try to get BC/BS to pay for this first.

Terry Newton </div></BLOCKQUOTE>
__________________
1980 ruptured L4-L5
1988 ruptured SI-L5
1990 ruptured C5-C6
1994 ruptured C6-C7
1995 Hemi-Laminectomy C5-C6, C6-C7 Mayo Clinic
Bicycle Accident 2004
MRI, EMG, Facet Injections, Epidural Blocks, Lumbar Discogram.
Stenum Hospital Surgery November 4, 2006
Prestige Disc C5-C6, C6-C7
Maverick Disc S1-L5, L4-L5
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