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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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  #21  
Old 09-02-2006, 03:13 PM
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Eddie_G Eddie_G is offline
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Join Date: Apr 2005
Posts: 238
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Well I'm about to open up a can of whoop-arse on Liberty Mutual. I hope to do it without a lawyer. I'll keep you posted.
__________________
12/16/03 Work Accident
Herniation and DDD at L4-L5
4/1/05 Discectomy
Epidurals and facet injections
5/15/06 Discogram confirmed L4-L5 DDD also an asymptomatic L5-S1 tear
10/24/06 L4-L5 Prodisc surgery with Dr. Goldstein
CAT scans & X-Rays show ossification
Trigger Point Injections, Medial Branch Blocks, Acupuncture, Weekly Deep Tissue Massage
10/27/08 Discogram (positive L5-S1 tear)
11/25/08 L5-S1 fusion with Dr. Goldstein
FAILED BACK SYNDROME
Liberty Mutual WC
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  #22  
Old 03-06-2007, 01:07 PM
Abbe Abbe is offline
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Join Date: Feb 2007
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Hi Laura,
I just got 2nd denial from Motion Picture Blue Cross. I would love to know how you got approved. I am looking at L3 L4 Prodisc replacement. Any help would be great!
Thanks,
Abbe
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Water ski accident 86'
Chiropractic& PT Pain meds
Discectomy Laminectomy
L5 S1 Partially sacralized
97' epidural injections
L3 L4 ruptured and torn
L4 L5 Almost no disk height left along with osteophytes
Left leg pain and tingling going down back of leg into heel & foot
3 appeals with BCBS no success Lost insurance.
Kaiser Permanente
L3-L4, L4-L5 Prodisc 9/18/09
C5-6 & C6-7 ruptured and looking at hybrid surgery fusion & Prestige ADR
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  #23  
Old 04-29-2007, 02:38 AM
motorman_darian motorman_darian is offline
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Join Date: Apr 2007
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Hi, I'd love to see the letter granting your successful appeal. I'm in the process of trying to get Aetna to approve a 2 level ADR at L4-L5 and L5-S1. I've been somewhat successful, I did receive approval for a 1-level ADR and the other for fusion, but from what I've read I think I'd be better off with 2 ADRs. Please email me at dgasgari@gci.net any information you think would be useful for my appeal. Thank you so very much!
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  #24  
Old 05-20-2007, 02:37 PM
gosolar gosolar is offline
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Join Date: May 2007
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I am putting together a packet and will be very happy to share with any interested. I am working to get a second Prodisc from Blue XS. I will keep you posted.

Harrison, I am SORRY iwas an idiot and idn't see the links before. Please accept my apology.

Meg
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Meg
Herniated Fragmented Disc L3-L4 with L3/L4 nerve root compression 2002
Far Lateral discectomy 2002
Prodisc Implantation L3-L4 2004
Multilevel DDD
Planning for L5-S1 Prodisc soon
Past Hoops player, surfer, left wing hockey player. CUrrently
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  #25  
Old 05-20-2007, 04:02 PM
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Harrison Harrison is offline
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Meg, no problem. There's too much information here for anyone; it is a challenge to organize. Good luck with all, and pls keep us apprised...
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"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
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  #26  
Old 05-20-2007, 06:53 PM
LBP LBP is offline
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Join Date: Aug 2005
Posts: 446
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motorman,

I am concerned that you are having problems getting 2 levels of ADR approved???? Everyone on here before seemed to have no trouble with multi levels with ADR. Why would Aenta approve 2 level Charite eaiser than 2 level ProDisc? Or are they tighening up on their approvals????

Anyone know more?
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Injured 9/01
Annular tears L4/5 & L5/S1
denied adr by insurance for 2 level charite as well as hybrid fusion at L5/S1 with Charite at L4/5.

New ins paid for 2 level lumbar prodisc surgery on 4/7/08 (at age 39) with Dr. Westerlund, at Core Orthop
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  #27  
Old 05-22-2007, 08:36 PM
Laura C Laura C is offline
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Join Date: Jul 2005
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I am sorry that I a have been away for so long. I will find the papers that will be important for an appeal and any info showing that the insurance covered it should help too. Anyone still wanting this info, could you please email me? Thanks!!!!
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Laura

Missing Facet Joint L5-S1
Collapsed Disc L4-5
DDD L3-4
Severe Stenosis
Disco + 3 levels
Sched. Oct. 11 - 2 level ADR & fusion
Dr. John Regan - L.A.
Awaiting approval!
[URL=http://www.lauracedar.com/XrayGallery]www.lauracedar.com/XrayGallery[/U
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  #28  
Old 11-28-2007, 08:13 AM
eileen gallagher eileen gallagher is offline
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Join Date: Nov 2007
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Laura,
I am gathering info for my 33 year old son, who has Empire BC/BS thru IATSE (International Actors Theatrical Stage Employees). since this union is in CA, I am hoping to have some sucess (my son lives in NY). My son needs a two level L4-L5 and L5-S1 (probably ProDisc). At this point the plan is to go to Germany but that might change if we could get paid in the US. Any info you can provide would be helpful (your approach and timing).
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  #29  
Old 12-28-2007, 06:45 PM
phylly phylly is offline
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Join Date: Dec 2007
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Hello Laura,
congratulations on your approval. I would also like the information on your appeal. I also have BC and was denied. I have BS as my primary and they denied me first the BC. I appealed to the IMR. I was denied again. I will still appeal although I already had the surgery by Dr. Delamarter and was a cash pay. I am so happy for you. I hope you do really well with your surgery. Keep us posted. this gives me some hope. Thanks for the info.
Phylly
__________________
Cervical fusion C4-C6 2002
Fall on tailbone April 2005
Discogram concordant at L4-S1 2007 for back pain not leg pain
Prodisc ADR surgery L4-L5-S1 November 2007
Decompression surgery L4-S1 for left sided sciatica July 2008
Continued back and leg pain, looking at possible fusion
Removal of Prodiscs and L4-S1 fusion February 2009
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  #30  
Old 01-03-2008, 01:38 PM
phylly phylly is offline
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Join Date: Dec 2007
Posts: 342
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Laura,
Please swend you email again I could not pull up you URL. I would love the info on your approval I am still woking on getting it retro approved and any thing you did would be very helpful.
Thanks so much,
Phylly
__________________
Cervical fusion C4-C6 2002
Fall on tailbone April 2005
Discogram concordant at L4-S1 2007 for back pain not leg pain
Prodisc ADR surgery L4-L5-S1 November 2007
Decompression surgery L4-S1 for left sided sciatica July 2008
Continued back and leg pain, looking at possible fusion
Removal of Prodiscs and L4-S1 fusion February 2009
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