Insurance Paid - Dr. Clavel 2 level ADR

[2Confused]

Herron,

Whoo Hooo!! It's great to hear that BCBS is stepping up and paying. It will be interesting to see what happens in the future as the health care bill goes into effect, I fear THE BILL will further limit and reduce the possibility of multi level ADR in the USA. Hopefully, private insurance will broaden out to include more opportunities for patients to make choices for medical treatment outside of the USA.

Congrats on your reimbursement!

[2Confused]

Laura,

If you want to know what we sent send me a private message....

Originally Posted by LauraB

I received a letter of non-certification from the "Medical Cost Management Corporation" for BCBS. I can't believe that they won't even consider fusion. Their "Principle Reason" is that my pain should be controlled with lifestyle changes and conservative treatment. They really want you to jump through hoops. Well since I'm the queen of record keeping, they will receive a 5 page letter outlining my "conservative" treatment along with doctors notes and results for the past 5 years. THIS THEY ALREADY HAVE! For goodness sake, BCBS paid for it! I have always been a firm believer that you never give up. These organizations rely on people throwing their hands in the air and saying, "oh well." Please let me know if there is anything else I can request or document while in Germany. I don't want to leave Dr. Bierstedt's office until I have whatever documentation, coding, etc. that can at least give me some chance of reimbursement; minuscule as it may be. I am elated to hear that many of you are being reimbursed, especially for multi-level. I am hopeful too. Congratulations for breaking the boundaries so the rest of us may pass!
My sincerest gratitude

[Jerry5]

To Laura B

Sorry, this placed my reply at the end, I had to log in to reply.

You are going to Germany, Dr Bierstadt?
This is with the German Spine Institute, how long did it take to get a reply from them, how much information did you send them, and what did they tell you about cost?, and did they file with your insurance company?

Sorry for all the questions, I have 3 discs in particular that are bad, L5-S1 is the worst, I don't really have a disc, and this has really strained the rest of the lower back, had a blow out at L2-3, and this was cleaned up a bit, with a discectomy, but it still aches and is now compromised.

Just had an Epidural, L4-5 and L5-S1, this hurt so bad (when the fluid from the epidural hit the L5-S1), that I could not breathe for a few seconds, there is NO way, I will have a Discogram.

Not going to happen, did you have a discogram?

Again, Sorry for all the questions.

Jerry

[kimmers]

Laura B,

I have heard of some people with international coverage saying that the surgery was done on an emergency basis and therefore BCBS or another ins. company would be responsible. It certainly seems like the insurance denials are getting overturned. They were not going to pay for my second lumbar surgery but I had primary and secondary coverage and they both paid. It is truly complicated as to who is denied and who is covered. When you see in the U.S. that the ADR surgery can be less expensive than fusion and then you add in all the problems that can happen with both but are more frequent with fusion, you see how short-sighted some of the insurance companies are.

K

[LauraB]

Jerry: Sorry I didn't respond sooner - I've been getting my business in order for my trip. Yes, to answer your question. I'm leaving Monday 9/2 for Germany for surgery with Dr. Bierstedt on 9/9. I'm having two level ADR (M6) for C4/5 and C6/7 with a possible C3/4 - only if necessary. My cost came to 28,000 euro with an additional 3,000 euro if the 3rd level is needed. It took about a week for Dr. B. to get back with me. I sent him my MRIs and Dynamic X-Rays - along with the diagnostic report in a zip file through "dropbox." Although they have had trouble receiving in the past, for some reason it went through for me. I had originally made plans for surgery elsewhere, but after hearing from Dr. Bierstedt, his team, and the overwhelming positive responses from this forum - I'm confident that I made the right choice! I don't like discograms (in fact, I've been reading that as a diagnostic tool, it really doesn't produce the best results and can certainly cause damage to the tested level). I would only do it if absolutely necessary, but once you have heard back from Dr. Bierstedt, he will let you know if any other tests may be necessary. You can certainly PM me if you are still waiting to hear from Dr. B. - I'll assist you if I can. I can only imagine the pain you must be feeling - I certainly hope that you can get some relief very soon. This is not the way we were meant to live.

Kimmers: Thank you for the suggestion. I will try the "emergency" route as well. I'm desperate to recoup some funds back. As most of us have dipped into financials that were not designated for this type of surgery, it would certainly be a blessing to have the insurance reimburse for even a portion of it. I will keep all of you updated as I enter into the brutal battle of the ambiguous insurance dilemma.

[TPatti]

Laura,
Do you have a worldwide rider? The worldwide rider seems to be the key to get any coverage. I do not have this and at this point am still thinking that I will not submit. My fear is that they could use to have me pay back for follow-up visits and PT saying that it is part of a illegal surgery that they did not cover. And, another payment on the surgery loan to be made tomorrow---

I am so glad that you have made a decision and wish you a safe travels tomorrow. There is an app called Pinger that allows free texting with wifi and you can make calls with wifi if you purchase minutes, about $5 for 100 minutes. Also, no English TV in Germany, you can use couchtuner to stream tv shows and movies with wifi-Rick(Gman) said this tip helped him out tremendously!

[2Confused]

Good luck to everyone - I think it is important that we push insurance to cover the costs of ADR surgeries overseas. I do believe that we have to be our an advocates and push for reimbursements.
My surgery was reimbursed by BCBS, I might mention that we sent the claim in directly to Worldwide Blue - not sure if that helped or not, but worth a mention.
It will be interesting to see if they reimburse me anything for the recent one year follow up visit.... (which I am happy to report that I am pain free & back to doing everything I want to do!!!)

[LauraB]

This is always great news! I did submit to Blue Cross Worldwide and awaiting to hear a positive response. You are absolutely right that we need to be our own advocate and keep pushing the insurance companies to do the right thing. So far my physical therapy had been preapproved and they're picking up 90% of the cost.

TPatti - I must have missed your message before my trip - so sorry. I wish I knew about the "pinger" it would have been extremely helpful - since my kids are "BIG TEXTERS." This would definitely be a good post for the travel information thread.

[jheumann]

Thank you and good luck to the rest of us.