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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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Old 09-22-2008, 02:44 AM
ceejay ceejay is offline
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Join Date: Dec 2007
Posts: 24
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I was in a car accident 4/06 with herniated disks and still undergoing conservative therapy With the
pain getting worse worse I am going to have to go for surgery This is the issue

My no fault insurance was discontinued after a 2 minute exam and the surgeon I want does not take my private insurance.I expect to get my no fault back after my lawsuit against them which will take forever Am I correct in assuming that my C Blue will not pay for under out of network
because it is not a covered service and experimental and when I get my no fault bacK I will have the same problem

Can anyone give me a heads up The impression I get on the board is that to private pay will cost 50-60 k
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Old 09-22-2008, 05:40 AM
Dave C Dave C is offline
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Join Date: Mar 2008
Posts: 153
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ceejay,

How many levels are you thinking about having done? It appears that most insurance companies are starting to approve 1 level ADR's since FDA approval, at least for the devices that have been approved. If you opt to go with more than one level, the chances of approval are greatly reduced.

Out of pocket costs will vary depending on which device and who performs the procedure. My recent two-level was $52,000. We are submitting our first official appeal today since my surgeon is going to absorb his part of the bill. That will drop my cost by $27,000. Still a bunch of money.

Good luck in your fight. We should not have to deal with such crap, but hey, it is the capitalistic way.

Peace out,
__________________
Dave

Diagnosed with DDD in Nov, 2007. MRI, EMG
C3/4 C4/5 C5/6 C6/7
Surgery 06.04.08--C5/6 and C6/7 with Prodisc was a success.
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