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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 08-24-2015, 08:54 AM
benihanna benihanna is offline
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Join Date: Feb 2015
Posts: 7
Default Going to Texas

Thanks for the reply, i am also sorry about your Moms cancer and wish u the best. Ive decided to just go ahead with Dr. Zigler at Texas Back cause i cant wait anymore. Insurance is covering a l5-s1 fusion and then im paying cash for l3-4-5 adr. Im going to still come after BCBS for at least one of the discs after but cant roll around in the dirt with them anymore for now. They did at least come down a little in price at Texas and i do have a lot of confidence in them. Maybe ill get lucky and get something back a few months from now when it gets to the board of insurance.
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36 year old male ddd s1-L5-4-3
Life long abuse and neglect, 2013 Discectomy semi-successful 2015 Steroid shots dont work anymore so i cant work
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  #12  
Old 09-24-2015, 09:20 PM
Cheryl0331 Cheryl0331 is offline
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Join Date: Dec 2010
Posts: 890
Default don't assume you'll be denied

Quote:
Originally Posted by Iron View Post
After almost a year and half of researching to figure out what was wrong with me and finding the best way to fix it, I am 99% sure I will be seeing Dr. Clavel very soon for a 3 level Cervical ADR.
I have researched this forum deeply trying to get the best answer just to remain confused as to the correct procedure and order of achieving a Reimbusement from my Insurance Company.
I have Blue Cross
Here is the question:
1. I have read people just going ahead and having the surgery, then sending the surgery info in to Blue Cross for reimbursement.
2. I have read also that people have gone the old preapproval route, sending their information in before.

I have already been through the appeals process for a one level all the way to the external review level, where I backed out because I have a multiple level problem.
Any assistance, guidance or oppinions will be soooo appreciated.
Thank you
I didn't ask for pre-approval. Later they can say they told you NO. Just file after the service. It's the ole' adage; "better to ask for forgiveness than permission." 1. Have a letter of medical necessity 2. show your conservative treatments for at least 6 months to a year 3. have your insurance codes and amounts in USD 4. show proof of money transfer 5. show proof of surgery/travel and surgery notes all in English. *Send it all registered mail!
__________________
54 yr old female 5'7" 147 lbs. non-smoker conservative treatments failed
2007 fusion @ C4-6 peek cages, failed due to long term use of cox-2 inhibitor
2008 revised C4-6 donor bone, plate & screws
2009 fusion with Roi-C @ C3-4
2015 MRI & CT mjr ddd @ C6-7, segmental kyphosis at C7-T1, 2-level M6-C prosthesis by Dr. Clavel Barcelona Spain
2019 H.O. formed behind M6-C @ C6-7 left nerve rt & in spinal canal.
2020 Revision C6-7 to a CP-ESP prosthesis by Dr. Schmitz Dusseldorf Germany
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