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The Big File All issues not easily categorized in the above forums are here. Comments on general health, diet, "getting comfortable," and more are here.

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Old 09-13-2005, 01:21 AM
cervie queen cervie  queen is offline
Senior Member
Join Date: Jun 1998
Posts: 264

I'm searching for answers here to my cancelled surgery. I'm not being even given a reason. The guy at Cedars Sinai hasn't returned my calls. Here's what I get at Medicare: "We don't pre-approve." Well, if you don't pre-approve how will I know if it's covered? "We covery surgery if it's Medically Necessary." Well, I can breathe and walk shnort distances...."Well, your doctor has to deem that it's medically Necessary." Well, OK, I guess he'll state that. "And the #2 criteria is that it is reasonable" Well it' shouldn't cost $1 million for a wheelchair. Where do I find a list of the devices that are prohibited or as the only other reason, unreasonable? I'll have to call my supervisor on that and call you back. Right. Absolutely zero answers. How can I fight what I don't know. I am only assuming that Medicare won't pay for my Bone Morophogenic protein for the fusion nor will they pay for the dynesis, but the denial came from the HOSPITAL, not Medicare of the Doctor.
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Old 09-13-2005, 01:54 AM
sahuaro sahuaro is offline
Senior Member
Join Date: May 2005
Posts: 455

Cervie queen: You sound increasingly desperate and frustrated, which is understandable. From what you have posted, the hospital refused to allow your surgery to be done there because Medicare sets the fees and they were refusing to accept those fees. Your surgeon and/or his billing office should be able to help you understand what procedures and devices Medicare will cover, based on their previous experiences in billing Medicare. I hope this helps.
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
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Old 09-28-2005, 05:24 PM
Posts: n/a

cervie queen:I too am trying to get ADR surgery booked at Cedars and I have Medicare. Dr. Regan's office tried to book the surgery months ago but the hospital refused to book. I later found that Medicare will pay but they are reimbursing too little for the disk itself. I think the disk is $11,500. I have tried everything and am about at the stage that you are.

I think I asked Gloria to give my tel. number to any other of his patients that are in this predicament but she never did.

I think Dr. Regan is willing to take what Medicare reimburses but the hospital is not.

Any ideas?
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