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 07-19-2008, 07:26 PM
ans ans is offline
Senior Member
 
Join Date: Mar 2005
Posts: 1,596
Default

Hi. I might need, pending a discogram and more facet injections, at least a fusion at L5-S1 and ADR at L4-L5 - a place that makes me nervous in case of trouble.

At one esteemed LA spine surgeon's office, the insurance person told me that with my coverage of BC of CA and BC/BS of NY (weak policy), that if I bill only for the one level fusion, they can deny this if they find out I had an ADR paid out-of-pocket. In the States, even this is expensive. I could alternatively try to get the ADR hybrid in full approved which of course would be a "no".

So is this how things are? That a person with a hybrid must pay for all levels out-of-pocket as an ADR at one level can preclude payment at all? I find this to be shocking.

Europe's to expensive for me. I know there's Pimenta in Brazil but don't know about his facilities, exchange rate - or anything other than he's respected. I think they ignored one person's attempts to contact them.

Anyhow, I sound like I'm complaining.

Just checking if people are encouraged to pay out of pocket for ADR/fusion hybrids, in toto.

Thanks and be well. - Allan
__________________
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.
Reply With Quote
  #2  
Old 07-20-2008, 03:05 AM
cathydownunder cathydownunder is offline
Senior Member
 
Join Date: Apr 2006
Posts: 297
Default

Allan, As you know I"m an Aussie so can't help you with the insurance part of things.
As a guide though I can tell you my health insurance fund paid out over $42,000 for my hybrid surgery 2 years ago. Interestingly, I've just looked up my recent 2 level fusion payout and it was "only" $25,000. Big difference!
Cathy
N.B. the exchange rate right now is almost equal.
__________________
Scoliosis 35*
DDD Everywhere!
The Usual Discograms Epidural Facet Injections etc
Maverick L4/5 Fusion L3/4
July 3 2006

Dynesys Stabilisation L4/5
Lt & Rt Facet Removal +Non-Bone Fusion L5/S1
May 26 2008
Reply With Quote
  #3  
Old 07-20-2008, 03:28 PM
Terry's Avatar
Terry Terry is offline
Senior Member
 
Join Date: Oct 2006
Posts: 1,210
Default

I did pay for my entire surgery out of pocket. My lawsuit against the homeowner whose dog took me out covered it and then BC/BS of Michigan also reversed their denial and covered my surgery. I was thrilled.

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
Reply With Quote
  #4  
Old 07-20-2008, 06:06 PM
ans ans is offline
Senior Member
 
Join Date: Mar 2005
Posts: 1,596
Default

Thank you for your replies. Cathy, great that you were covered, and Terry, glad you won the battle (but how?). Looks like it took a "pound of flesh" to pay for the out-of-pocket costs and that nasty looking pitbull in our building's looking better.

Heal well people. - ans
__________________
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.
Reply With Quote
  #5  
Old 07-23-2008, 02:00 AM
kimmers kimmers is offline
Senior Member
 
Join Date: Jan 2008
Posts: 554
Default

Allan,

If you find an answer to get insurance to cover ADR, please tell everyone. I have Blue Cross of California and they are some unprintable name.
I can't believe insurance companies are so stupid.
I like my ADR and yet I continue to fight BC and tackle workers comp also.
I keep thinking what would have happened if BC just approved the ADR when we asked for it. I would probably still be employed.
A lot of times I have just wanted to throw up my hands into the air and say, "who cares. You bleeping Blue Cross."
With wc, I have to prove that lifting patients and heavy stuff, caused my DDD. To me it is a no-brainer, but I am the one who was going to massage therapy because my lower back was hurting more and more. I didn't have a clue about DDD.
I feel like nobody is cutting ADR patients a break. I mean nobody from the private insurance companies (other than Aetna, Cigna, Kaiser). Like I always say, what use is insurance if you cannot use it?
I would fight for every little thing. I don't think insurance companies can deny care because you self-paid for an ADR.
I think that is a scare tactic, but ask someone more knowledgible in insurance law.
Again, my two cents--for whatever it is worth.

Kimmers
__________________
hurt back lifting, herniated disc at L4/L5. DDD
Reply With Quote
  #6  
Old 07-23-2008, 02:09 AM
ans ans is offline
Senior Member
 
Join Date: Mar 2005
Posts: 1,596
Default

Kimmers: I agree with you and thanks for your response. I note that you, a nurse, got denied 3X. Now this is discouraging and if I do go for it, we should get a team to work together and fight. (I used to be a researcher-type). I take it that you used The Insurance Warrior's advice, etc.

I admire your guts and perseverance. Anyone know a person in network news who could cover your story? Shame on them - or, shame them.

Allan
__________________
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.
Reply With Quote
  #7  
Old 08-01-2008, 07:21 PM
Juli Juli is offline
Senior Member
 
Join Date: Apr 2005
Posts: 191
Default

My insurance company paid for the fusion and hospital stay and all. I just wrote a check to my doctor for the charite fee, 20k for two, and had to pay the out of network costs for the rest of the stuff.
__________________
Juli
DDD L3-L4 on down since 1990
Surgery 9/26/05 with Dr. Bitan in NYC to complete partial congenital fusion of L5-S1 and ADR at L3-L4 and L4-5.

Feeling great!
Reply With Quote
  #8  
Old 08-02-2008, 08:09 AM
ans ans is offline
Senior Member
 
Join Date: Mar 2005
Posts: 1,596
Default

Juli, I"m glad you are feeling so well.

Did Bitan's people even mention that you were to get an ADR or did they mention only for the fusion part.

If you wish to keep this private, then please PM me. Btw, what insurance company did you have?

Thank you for your time. I hope that you've recovered most of your life back!

W/Regards, Allan
__________________
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.
Reply With Quote
  #9  
Old 08-04-2008, 04:10 PM
Juli Juli is offline
Senior Member
 
Join Date: Apr 2005
Posts: 191
Default

Hi ans,

I believe they did submit the whole thing though we knew upfront that they would most likely not pay for the discs. I have United Health Care.

Thanks, I feel fantastic, best money I ever spent.
Hope things work out for you.

Juli
__________________
Juli
DDD L3-L4 on down since 1990
Surgery 9/26/05 with Dr. Bitan in NYC to complete partial congenital fusion of L5-S1 and ADR at L3-L4 and L4-5.

Feeling great!
Reply With Quote
  #10  
Old 08-05-2008, 01:55 AM
kimmers kimmers is offline
Senior Member
 
Join Date: Jan 2008
Posts: 554
Default

Allan,

Has Blue Cross budged?
I am so entirely pissed off at them. I got a denial the other day for a CT exam I had at my sinus doctor's office. Now, these exams are pre-approved before they are done.
There is no way I will pay for this.

Just another example of Blue Cross's idiocy.

I am praying that Anthem/Blue Cross goes out of business. It would be just desserts. I can tell you I saw recently in the newspaper that BC/Anthem was fined 11.3 million for approving surgical procedures and then rescinding the policies of people after the surgery was done.

And here we are looking at a $63,000 hospital bill for my ADR surgery. They have quite a racket going on, denying ADR.
I learned a few things about appeals so I can help, but you cannot reason with BC. They are like a dictatorship.
I am not kidding when I say they are evil.

Sure, I studied Laura's book and e-mailed her for advice.
All in all, I would have ADR over fusion and am pleased with the ADR results so far even if it is a roller coaster ride.
__________________
hurt back lifting, herniated disc at L4/L5. DDD
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



All times are GMT -4. The time now is 04:21 PM.


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