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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 06-11-2007, 08:32 AM
Julaine Julaine is offline
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Join Date: May 2005
Posts: 39
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well we were hoping they would approve the removal of my hardware and allow a adr on my L4, with myself paying for the disc, but they denied everything. They said that the adr is investigational/ not medically necessary, and also the removal of the hardware is not necessary.
One would think if they need to remove the hardware that for some reason a fusion is not the best option and that ADR would be the key. But they just want me to get another fusion.
The last injections I had were 14,000, I am tempted to call them and say I will keep getting these injections that do nothing. They will pay for us all to become dependant on serious mind altering drugs, but will not take a chance on a surgery that could in the long run save them alot of money.
I dont know what to do at this point. I cannot drive, I am constantly falling. My kids are suffering as well. I am going to need a care giver to come in and take care of me.
Where do I go from here?

Thanks,
Julaine
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Back pain 16 years Chiropractic care 1993-1994DX 2003 DDD at L4 5 S 1January 04-Nov 04 Epi Injections October 04- March 05 Morphine, vicodin, Duragesic, June 05:Blue cross denied my two level ADR
august2005 woke up and had no feeling in legs was in
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Old 06-11-2007, 10:43 AM
ZorroSF ZorroSF is offline
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sweet geesus WTF?!

$14000 for injections? they want to remove a fusion and replace it with a fusion?

First off, I'd say stay away from Ultram. that stuff is garbage as far I'm concerned. it makes your mind numb and your stomach nausiated. I'd get them to prescribe something like Dilaudid and wean you off over time as needed.

BTW who's your doctor in LA? As for the denial, had it been disapproved before and this was a greviance process, or was this the first denial?

This is something I would pursue right away;

http://adrsupport.org/eve/forums/a/t...1/m/8571067452

I'm in the process of reading this. Afterwards I need to follow through and demand the doctor is reimbursed since Blue Shield of CA has denied me too.

It's a hard fight, and it's all the worse cause you're in pain the whole time and don't have time to waste chasing your insurance. blue cross/blue shield/regent healthcare group is a big scam as far as I can tell.

Sorry to hear about this predicament, but start on that demand for the insurance to pay. We are pioneers in this right now and that book was the only thing I could find, outside of hiring an attorney.
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***********************
1/2006 DDD L5/S1

Prodisc St. Mary's 12/2006 not diagnosed properly pre-op and now have DDD L4/L5, facet calcification L5-S1/L4-L5, mild scoliosis and left knee pain. DDD: C3 through C6
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Old 06-11-2007, 10:46 AM
LBP LBP is offline
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Join Date: Aug 2005
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Please send your story to Harrison. He will forward this to the Oprah show...read our thread in the big bucket if you haven't already.

I am so sorry you are getting the run around. It is crazy..you have a failed fusion and they are refusing to let your try an alternative before another fusion!

(Email address deleted to prevent spambot address collection).
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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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