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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 02-20-2008, 11:33 PM
MR D MR D is offline
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Today I received approval from HealthNet (PPO) for a 3-Level Prodisc-C. I am shocked that the insurance company approved it for all 3 levels. I am sure that the letter my ENT doctor wrote as part of the appeal, stating that the fusion would make my swallowing and sleep apnea worse, made all the difference. I am hoping to hear from my doctors coordinator to find out the surgery date.
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Multiple serious car accidents in 1985 (none my fault), no MRI's taken. After semi recovery, severe headaches began one day in 1995 and have been daily since (migrane, cluster or chronic). I have tried everything available to prevent them, and later
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Old 02-21-2008, 11:26 AM
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Terry Terry is offline
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Mr. D:

Congratulations on your successful appeal. It sounds like you are in good hands and I wish you good-luck on your surgery date.

Terry Newton
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1980 ruptured L4-L5
1988 ruptured SI-L5
1990 ruptured C5-C6
1994 ruptured C6-C7
1995 Hemi-Laminectomy C5-C6, C6-C7 Mayo Clinic
Bicycle Accident 2004
MRI, EMG, Facet Injections, Epidural Blocks, Lumbar Discogram.
Stenum Hospital Surgery November 4, 2006
Prestige Disc C5-C6, C6-C7
Maverick Disc S1-L5, L4-L5
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Old 02-22-2008, 12:16 AM
Slackwater Slackwater is offline
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Quote:
Originally posted by MR D:
Today I received approval from HealthNet (PPO) for a 3-Level Prodisc-C. I am shocked that the insurance company approved it for all 3 levels. I am sure that the letter my ENT doctor wrote as part of the appeal, stating that the fusion would make my swallowing and sleep apnea worse, made all the difference. I am hoping to hear from my doctors coordinator to find out the surgery date.
This is good news. I am pleasantly surprised and happy for your sake. Take care,
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2004 MVA, 2-level lumbar surgical candidate
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Old 02-27-2008, 11:08 PM
MR D MR D is offline
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It's now official, my surgery date is March 10th at St. Johns. My doctor is completely blown away that the insurance company approved it. Apparently from what I'm hearing, everyone else is being denied, even for singles. In the approval letter they even noted the continued success rate of the ADR over fusion. I think it's a miracle and I'm so happy... to think I might be able to have a life again and possibly go back to work. Thank you for all support that everyone has shown to me and my situation. I hope that my surgery will pave the way for more and more approvals and willingness for insurance companies to approve this necessary option for everyone.
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Multiple serious car accidents in 1985 (none my fault), no MRI's taken. After semi recovery, severe headaches began one day in 1995 and have been daily since (migrane, cluster or chronic). I have tried everything available to prevent them, and later
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Old 04-01-2008, 12:56 PM
mmarsh mmarsh is offline
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Mr D

Sure hope your surgery went well. When you're feeling up to it could you share your info? I could use it for my appeal. Need surgery date, location and ins co. YOur name is helpful but not necessary.

Thanks and good luck-

Missy
mdm798@aol.com
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fusion L4-5, Dynesys rods L3-4, fusion c5-6 and C6-7, current problem C-7/T-1
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Old 05-13-2008, 01:04 AM
MR D MR D is offline
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Missy,

Sorry I didn't read this until now...

My surgery date was March 10th, 2008 at St. John's Hospital in Santa Monica. My surgeon was Dr. Kropf who is part of the Spinal Institute of Santa Monica. My insurance is HealthNet PPO is is a small group policy.

For more details read above. My post surgery details are under the "Surgical Outcome forum".

Let me know if you need anything else.

Good luck,
Mr. D
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Multiple serious car accidents in 1985 (none my fault), no MRI's taken. After semi recovery, severe headaches began one day in 1995 and have been daily since (migrane, cluster or chronic). I have tried everything available to prevent them, and later
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  #7  
Old 05-17-2008, 11:14 PM
ans ans is offline
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This is fantastic! I saw Kropf for an opinion. Wishing you well. - ans
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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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