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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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  #1  
Old 06-09-2005, 11:46 AM
bclervi bclervi is offline
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Hi!
I am waiting to have a lumbar disk replacement done and I have been denied by my Insurance. The insurance is Blue Cross Blue Shield.

Is anyone getting their paid for in the US by insurance?
thanks, Becky
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Becky
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  #2  
Old 06-09-2005, 11:54 AM
David David is offline
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I think that most people here in the forum can relate to your issue with U.S. insurance companies.

Very few of us here (of which I am aware) - if any - have gotten any U.S. insurance companies to cover ADR surgery. In my case, I should find out in the next few weeks if UHC will cover me or not (I am very doubtful that they will say yes).

Not that it will help much, but if you decide to try and appeal the denial, some ammunition that might help you:

Aetna approval for Charite ADR:

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

Horizon BCBS of NJ approval for Charite ADR:

http://www.depuyspine.com/about/about.press.040605.asp

David
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47 years old
Surgery: 14-NOV-2006; Straubing, Germany (Dr. B.)
L4-S1: Prodisc
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  #3  
Old 06-09-2005, 12:17 PM
Juli Juli is offline
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Yeah, I think BCBS is one of the few that have ponied up. You might be one of the lucky ones Becky. Good Luck! I am submitting my request next week, also to UHC and expecting a denial.
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Juli
DDD L3-L4 on down since 1990
Surgery 9/26/05 with Dr. Bitan in NYC to complete partial congenital fusion of L5-S1 and ADR at L3-L4 and L4-5.

Feeling great!
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  #4  
Old 06-09-2005, 05:09 PM
rickz68 rickz68 is offline
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My insurance company has been denying me for over a year. I have Health Net as my carrier. I even looked into litigation to get them to pay but it wasn't in my favor financially.

I did hear from someone at the Texas Back Insttute that Definity Health has been covering some ADR procedures.

I went to my surgeon, Dr. Regan, yesterday and he informed me that they have been having some success getting UHC to cover some procedures.

Good Luck.
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Pain since age 18.
DDD L5/S1
Health Net approval July 19, 2005
Charite w/Dr. Regan - Sept 13, 2005
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  #5  
Old 06-09-2005, 05:12 PM
David David is offline
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Quote:
Originally posted by rickz68:
[qb]
I went to my surgeon, Dr. Regan, yesterday and he informed me that they have been having some success getting UHC to cover some procedures.
[/qb]
Thanks for that info! Sounds promising to me.

David
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47 years old
Surgery: 14-NOV-2006; Straubing, Germany (Dr. B.)
L4-S1: Prodisc
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  #6  
Old 06-09-2005, 05:43 PM
Melody Beattie Melody Beattie is offline
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My insurance (comprehensive with STate Farm, very similar to BCBS) told me before the surgery that they would pay -- and I had my surgery in Germany. Now we have to see if they actually do. They said all they needed was proof that the surgery was approved in the US, and that it was performed by a legitimate doctor in a legitimate hospital setting. I had two levels, but in preparation for a fight re that, I have read that the FDA in the U.S. occasionally approves a two-level surgery here under their "compassionate use" clause, so I'm tucking that in my back pocket for ammo. I've submitted my claim and will post when I get a response. Good luck.
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Melody L Beattie
ADR L4-L5 and L5-S1 April 15, 2005
Thank you Dr. Zeegers and my fellow
spineys on this forum
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  #7  
Old 06-10-2005, 08:07 AM
hurtjay22 hurtjay22 is offline
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bclervi, I have BCBS and am hoping that they will cover my surgery since its one level, which has been approved by the FDA. Why has BCBS denied covering your surgery. Are you getting multiple levels done?

Jay
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-Fell down icey steps Jan. 2004
-First MRI revealed bulged disc L4-L5
-Injections in Arpil 2004
-Second MRI revealed L4-L5 bulged disc and DDD
-Discogram May 2005, confirmed L4-L5 as pain generator
Fusion L4-L5 Oct. 2005
SCS implanted July 2006
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  #8  
Old 06-11-2005, 03:56 PM
walker walker is offline
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I have BCBS of OK. I was denied adr in early March '05 (investigational/experimental). I have been in the first step of the appeal process since then. No word yet.
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L5/S1 Ruptured DDD
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  #9  
Old 06-12-2005, 12:54 AM
paulam310 paulam310 is offline
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bclervi, I had 3 levels done in December of last year. My Blue Cross PPO covered the procedure. The doctors office called my insurance company then called me back within a week and told me it was o.k.'d and wanted to schedule for surgery. They treated my surgery like any other spine surgery.
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3 level prodisc C4-5,C5-6,C6-7
12-04
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  #10  
Old 06-13-2005, 12:00 PM
paulam310 paulam310 is offline
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bclervi, thanks for your PM. I am slowly getting better, I would like to emphasize "slowly." It takes time for the body to recover from such invasive surgery. Prodisc is not FDA approved yet. There are clinical trials happening around the country at special designated sites. If you need only one level for the low back and you qualify for the trial, you could probably get it at any of the locations. Anytime you deal with low back multiple levels or the cervical levels, there are fewer prodisc sites that seem to be willing to do them. If you need more info on this let me know. As you see I was a 3 level cervical. My doctor doesn't seem to be having much trouble getting the adr surgery approved. They told me before surgery how much my insurance would pay. My doctor is even doing surgery on 2 and even 3 level worker's comp adr patients. Hope this info helps.
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3 level prodisc C4-5,C5-6,C6-7
12-04
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