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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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  #1  
Old 12-11-2010, 05:59 AM
colorado2718 colorado2718 is offline
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Join Date: Nov 2010
Posts: 22
Default United Healthcare and ADR/TDR

UHC is my insurance company and I found a link to their "Artificial Total Disc Replacemetn for the Spine" Medical Policy statement that has me concerned. The link for this document follows:

https://www.unitedhealthcareonline.c..._the_Spine.pdf

This policy statement says "Artificial total disc replacement is unproven for the treatment of single or multiple level degenerative disc disease of the lumbar spine in skeletally mature patients."

This is a 15 page document that covers quite a bit of good information but in the end, despite the encouraging data, they conclude that the sample sizes are too small, some trials weren't controlled well enough and there hasn't been enough time or study to make a determination on the efficacy of ADR/TDR.

When I read this document, it seems to imply that ADR/TDR wouldn't be covered by UHC, but it doesn't actually say this anywhere that I can find.

I did some searching on this forum, but didn't find and answer to my question about whether or not UHC will cover ADR/TDR - do any of you know the answer to this?

Thanks for your help!
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Old 12-24-2010, 08:49 PM
prusinski prusinski is offline
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Join Date: Jun 2010
Posts: 11
Default I'm working on this also.

Hey Colorado,

I'm working both streams for ADR against UHC, my private carrier and Travelers, my WC carrier from Illinois. I'm a Wisconsin resident and the surgical team at Rush University Hospital asked me to work with them to push preauthorization from both carriers to see which breaks first. This is the plan because WC is so time consuming.

I'll provide feedback when it occurs. Right now, I'm working on my first appeal to UHC. I'll post PRN.

Thanks,

Bob
__________________
DDD, L5-L6 (yes, L6!), L6-S1 naturally fusing,
ILWC L5-L6 ALIF recommended - not acceptable ,
my Neurosurgeon ordered ProDiscL ADR 6-2010,
still fighting ILWC for ordered ADR treatment.
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