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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 10-16-2009, 03:00 PM
mattshell mattshell is offline
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Join Date: Oct 2009
Posts: 4
Default Paid cash for ADR because Aetna denied me

Has anyone paid cash for ADR after Aetna Denies claim and succeed in reimbursement from Aetna ?
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  #2  
Old 10-17-2009, 02:33 AM
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steve55 steve55 is offline
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Join Date: Jun 2008
Posts: 127
Default Yes

Yes, I knwo of one person who was approved multi level ADR, and I sent my multi level ADR appeal into Aetna 3 weeks ago, waiting to hear back now.
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4/08- DDD at C5/6 & C6/7 & bulging discs. C5/6 portrusion.

6/08- Disco results- C6/7 painful, C5/6 popping sounds

7/08- Plasma disc decompression-significant relief obtained

11/08- pain returned to almost pre surgical levels

1/09 -Disco w/ Dr Ziglar shows C5/6 & C6/7 painful-2 level ADR recommended

2/26/09 - c4-c7 ADR Prodisc Nova with Dr Bertagnoli. 100% Success but need C6/7
ADR revision due to subsidence.
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  #3  
Old 11-30-2009, 10:01 PM
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steve55 steve55 is offline
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Join Date: Jun 2008
Posts: 127
Default Update

I was declined. I spoke with an attorney who had handled many single level ADR cases and he says precedent carries little legal weight. Insurance co's are not bound to approve people for a procedure based on precedent alone. He says I could have 50 cases of precedent and they dont care.

Laurie Todd was kind enough to write me back and said:

" I am so sorry that you lost your appeal.

Even I don't win every appeal. As of now, I have won forty-eight, and lost two.

One of the appeals that I lost had seventy-one cases of precedent, thousands of peer-reviewed medical journal articles, and the expert surgeon had performed 1600 of them. The appeal that I won last week was a surgery for a condition that is so rare that the expert surgeon had only ever done seven surgeries for it, I had NO cases of precedent, and there had only ever been ONE journal article ever published about it.

The appeal that I lost was eighty pages long, and the appeal that I won last week was twenty-five pages long.

In the book and the CD, I have described the writing and fighting of an appeal as best I can. There is, I suppose, an indescribable element of attitude, strategy, tone ... an underlying something that turns the tide."



American health Insurers are nothing short of crooks. Good luck fighting them, you'll soon find out you have no power.
__________________
------------------------------
4/08- DDD at C5/6 & C6/7 & bulging discs. C5/6 portrusion.

6/08- Disco results- C6/7 painful, C5/6 popping sounds

7/08- Plasma disc decompression-significant relief obtained

11/08- pain returned to almost pre surgical levels

1/09 -Disco w/ Dr Ziglar shows C5/6 & C6/7 painful-2 level ADR recommended

2/26/09 - c4-c7 ADR Prodisc Nova with Dr Bertagnoli. 100% Success but need C6/7
ADR revision due to subsidence.
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  #4  
Old 12-04-2009, 12:02 PM
ans ans is offline
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Join Date: Mar 2005
Posts: 1,596
Default

I am so sorry about this. A while back, your insurance company seemed to be ADR-friendly. What happened?

To the fellow who posted to you (sorry, pulling an all-nighter/stupid/lazy), congratulations. Man, I'd like to see your appeal 'tho I'm not an ADR candidate.

Best...
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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.
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