Did your insurance pay? Let's help one another - Page 8

ernie · #71 05-10-2005, 03:46 PM

I am new to this , so if I make a mistake, please correct me. My daughter, age 33 has been laying on the floor 3 years,FDA has approved 3 level prodisc at PENNA HOSPITAL PHILA, TEXAX BACK SAYS SHE NEEDS 3 LEVEL. AETNA WILL NOT PAY. HAS AETNA PAID FOR ANY ONE ELSE. Thanks for the help
Up date may 13, 2005 Penna Hospital In philadelphia,
June 22,05 3 level PRO-DISC, COST 49,300- INS NOTHING, ON 3RD APPEAL AETNA! RESULTS 11 WEEKS POST OP- 100% PAIN FREE, OVER HER LIFE SPAN COME OUT TO 856.00 PER YEAR. pOLITICIANS ARE JUST THAT, NO GOOD
KEEP ON FIGHTING, WE ARE GOING FOR OUR THIRD APPEAL. SHE GOES BACK TO WORK SEPT 21,05 2" TALLER AND 100% PAIN FREE
gtOOD LUCH TO ALL, AND THANKS FOR A GOOD SIT.

David · #72 05-10-2005, 03:55 PM

At this point in time, I believe that Aetna has approved ADR as medically necessary for one level, but not for three...

http://www.aetna.com/cpb/data/CPBA0591.html

(that being said, perhaps someone else could prove me wrong)

David

NCFUSED · #73 05-10-2005, 04:09 PM

David you are correct, Aetna will pay for 1 level Charite, as the FDA has only approved 1 Level using the Charite device at this time.

Multi-level operations using Charite and other devices are only in FDA Clinical trials at the moment.

paulam310 · #74 05-11-2005, 10:27 PM

Rein, I wish that I had some insights to post for you, but I don't. All I can say is that Delamarter's accounting department told me even before my surgery what my insurance company would pay which means they had had experience with BC PPO paying for these adr surgeries before. The only person I owed money to after my surgery was the doctor because he was out of network. Good luck, don't stop fighting for the surgery, it is worth it.

hucky · #75 05-12-2005, 06:09 PM

Hi,

I'm wondering if there are any Australian Third Party Insurance ADR candidates out there. I've been approved for a discectomy and fusion on the C6/7, but have been denied ADR as it's considered as "experimental". My private health insurance will pay for it - so can't understand why one insurance co considers it experimental and the other not. If my 3rd party insurance won't approve after appeal - at least I can go with my private insurance - but will be approx. $4,000 out of pocket!

If there are any other Ozzie ADR approved 3rd Party candidates out there - would you let me know how you got their approval.

Hucky

Eddie_G · #76 05-13-2005, 03:20 PM

Liberty Mutual anyone??? ....ANYONE?????

walker · #77 05-14-2005, 12:14 AM

I just want to thank everyone who has contributed to this thread. LOOK-4 pages of great information.

My doctor's office called me this week to check on my progress with the BC/BS of Oklahoma. I have been calling the insurance co. several times a week every week. As it turns out, doc's office never sent a letter to start the process. Quote from my dr's office: "Everyone thought that someone else was taking care of it." It is May 13 and my precert denial was March 4. Talk about losing faith in someone.

I'm just getting by right now. I appreciate the support from the members here that have been talking to me along the way. Without you and this website--I probably would have settled for soemthing I really don't want. Thanks guys. Thanks Nikki.

All you insurance warriors----STAY WITH IT!!!

Kim · #78 05-14-2005, 10:09 PM

Nikki
Hang in there! Been there done that. I have had to check up on the docs office, ins company, HR etc every step of the way to make sure they are doing what they were supposed to do. You would be appalled to know HOW many times I got the story you did.
You have to check and double check and triple check. Call the docs office and aggravate the bejeebers out of them. The SQUEAKY wheel gets the grease. It appalls me that we have to do this. I have worked in the medical profession in one aspect or another for over 20 years and I am ashamed of the medical care that we get at times.
If you need to talk please feel free to PM me. We have to work together.

walker · #79 05-15-2005, 11:18 AM

I mean thanks to Nikki. She has been an angel in my quest for more information and new hope.

Kim, I am sorry that we have to be the squeaky wheels. It's funny you said that because that's exactly what I told my doc I was gonna be.

I have kept track of names and date of the people I have talked to at the ins co and doc's office. This has already come in handy. I have a file two inches thick on the info I have acquired. Most of it came from here in one way or another. After visiting with the folks at this website, I have only become more determined and more informed.

My name is LaJeana, and I am sick and tired of being sick and tired! :-)

Kim · #80 05-16-2005, 11:19 PM

OOOps sorry about the name thing

that goes to show you how you can mess up when you are reading too much too quick.
LaJeana keep up the work. Yes I take names and always ask for names when I call the drs office. I find its a great help to talk to the same person as much as I can. If they remember you its much easier to get something done. Also if they know you will call and frequently lol they will get on the ball and get what you need done.
I am sick and tired too and its a shame we have to do this. Hopefully at least if nothing else we will be helping those who come after us have an easier time of getting this surgery done. I have found this site and the people on it more valuable than gold in my quest to get my back taken care of. I would be lost without the kind folks here who have gone before me. I just hope I can pay it forward to the next one in line.
Kim