ADRSupport Community  

Go Back   ADRSupport Community > General Discussion > Insurance Hell

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.


Reply
 
Thread Tools
  #1  
Old 02-08-2010, 02:11 PM
Berylcooks Berylcooks is offline
Junior Member
 
Join Date: Aug 2009
Posts: 4
Wink Current Lawsuit against Blue Cross Pro-Disc Denials ( Help Wanted )

We are currently beginning a suit against BC/BS for the denial of coverage for Pro-Disc L.

Would love to connect with others who have been denied coverage for this FDA approved procedure.

Last edited by Harrison; 07-12-2010 at 04:14 PM. Reason: Deleted email address -- pls use private messaging!
Reply With Quote
  #2  
Old 02-08-2010, 11:09 PM
haayers haayers is offline
Junior Member
 
Join Date: Feb 2010
Posts: 5
Default

Just starting out on this journey. My husband is a candidate for surgery, so I called BCBS and read them the CPT codes the surgeon gave us. They told us it is not covered. They considered it "experimental". What? The FDA approved it, right? Makes no sense to me. Really frustrated right now....don't know how we are going to get this surgery done, except to pay out of pocket. Incidentally, I happen to work for BCBS so it's a rather sticky situation for me to be in.....
Reply With Quote
  #3  
Old 02-09-2010, 05:54 PM
Berylcooks Berylcooks is offline
Junior Member
 
Join Date: Aug 2009
Posts: 4
Default

would you like to join us and work to remedy this?

we went through the appeals process (first, second and third) and ended up paying out of pocket. good news is our son is now much better. please contact me if you want additional information,
Reply With Quote
  #4  
Old 02-09-2010, 06:24 PM
Harrison's Avatar
Harrison Harrison is offline
Administrator
 
Join Date: Oct 2004
Posts: 7,010
Default

Beryl, there may be some confusion about the "join us" part of your question. Can you spell out what you mean by this please?

Thanks!
__________________
"Harrison" - info (at) adrsupport.org
Fell on my ***winter 2003, Canceled fusion April 6 2004
Reborn June 25th, 2004, L5-S1 ADR Charite in Boston
Founder & moderator of ADRSupport - 2004
Founder Arthroplasty Patient Foundation a 501(c)(3) - 2006
Creator & producer, Why Am I Still Sick? - 2012
Donate www.arthropatient.org/about/donate
Reply With Quote
  #5  
Old 02-11-2010, 09:06 PM
haayers haayers is offline
Junior Member
 
Join Date: Feb 2010
Posts: 5
Default

Yes, I was just about to ask that. What do you mean by join us? Like I said in my reply, I work for them, so I need to tread lightly on what I do/don't do. But, yes, we need them to pay for this surgery! We've gotten an estimate from the Dr. that it'll be approx. $100,000 to pay out of pocket. We also found a high risk pool that would take my husband w/ the pre-existing condition, the insurer is Healthnet. Anyone have any experience with Healthnet HMO? Not sure if this is the right thread to ask, or if I'll also open up a new thread.
Reply With Quote
  #6  
Old 02-11-2010, 11:27 PM
sahuaro sahuaro is offline
Senior Member
 
Join Date: May 2005
Posts: 455
Default

I had HealthNet PPO and they absolutely did not cover my ADR surgery--the appeals process was a joke...
__________________
2001 MVA; C5-C6 disk extruded
ongoing physical therapy, exercise and massage
ESI's, oral prednisone, trigger point injections
foraminal and central stenosis C5/C6 and c6/C7
2007 EMG/nerve conduction shows pattern of chronic radiculopathy
January, 2008: Prestige ST Artificial Disk Replacement, C5/6
Reply With Quote
  #7  
Old 02-12-2010, 12:06 PM
Berylcooks Berylcooks is offline
Junior Member
 
Join Date: Aug 2009
Posts: 4
Default

what we mean is to get stories and people together-right now we are investigating this. we are going forward in a suit-whether or not other choose to join us...who knows? hope this clarifies.
Reply With Quote
  #8  
Old 02-21-2010, 05:17 PM
VegasTech702 VegasTech702 is offline
Junior Member
 
Join Date: Jul 2009
Posts: 7
Default BCBS of IL

I just had a cervical ADR at c4-c5 in July and BCBS of IL covered it. It took a lot of cooperation from the doctors assistant and a lot of my time and a huge phone bill but we were able to get it resolved.

Why would they cover cervical but no lumbar? Now I am needing a lumbar ADR and we have not yet submitted for preapproval yet. I hope this doesn't mean am going to face a brick wall...
Reply With Quote
  #9  
Old 02-25-2010, 05:01 PM
beasage03 beasage03 is offline
Junior Member
 
Join Date: Nov 2009
Posts: 2
Default

Join us as in doing a class action lawsuit?
Reply With Quote
  #10  
Old 07-11-2010, 08:55 PM
jamie5136 jamie5136 is offline
Member
 
Join Date: Oct 2008
Posts: 66
Default There is a reason you are denied; it is not as safe as you think or have been told.

You will lose against BC, I did, plus, I did a three level ADR in Germany and am disabled now; worse than before. Think first and do more research about Pro-Disc L. It ruined my life. I was young and successful; I know feel old and bitter and poor. 2 of the 3 sank into my bones; I can't sit/lay down; pains all over. I did my research too, but it truly is experimental, in my opinion. If I had to do it all over again, I would have had a fusion at 2 of the levels and maybe an ADR at one. Read about subsidence (mine did and I don't have a bone issue) and read about facet issues.... read about how to remove if it goes bad; you can't really w/out much risk.
Reply With Quote
Reply

Bookmarks

Tags
blue cross, denial, pro-disc l, suit

Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off


Similar Threads
Thread Thread Starter Forum Replies Last Post
Blue Cross Blue Shield ADR Denial finally reversed ZorroSF Insurance Hell 17 01-30-2014 07:46 PM
Blue Cross Blue Shield {aka Blue Crap} chasswen Insurance Hell 16 06-06-2012 05:03 PM
blue cross denied bi level pro disc rayray_1 Insurance Hell 14 11-26-2007 12:04 PM
Blue Cross Blue Shield ADR Coverage stuschulz Insurance Hell 10 09-24-2007 09:54 AM
Technology Evaluation Center Blue Cross Blue Shield Abbe Insurance Hell 2 07-03-2007 07:30 PM


All times are GMT -4. The time now is 09:55 AM.


© Copyright 2006-2023 ADRSupport.org All rights reserved.