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  #1  
Old 06-15-2014, 05:05 PM
Iron Iron is offline
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Join Date: May 2014
Posts: 13
Question Lindstrom Healthcare Advocacy

Hello, I am new to this group. I have been denied twice for ADR surgery at C 5 by my insurance company ......Blue Cross of Idaho. I am considering using the assistance of Lindstrom Healthcare Advocacy to try for a reversal. Any input would be greatly appreciated.
Thanks, Mike
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Body Builder/Trainer
C5 Radiculopathy- with only major weakness in right bicep and deltoid, no pain. Unacceptable
Insurance denial of ADR
Grade 2+ spondylolesthesis at L5/S1 (I can deal with the pain as long as I am active)
May 8 2015----3 Level Cervical ADR @ C4-C5-C6
With Dr. Clavel
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Old 06-15-2014, 06:16 PM
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Kelly4ADR Kelly4ADR is offline
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Hi iron,
Lindstrom is a legal firm, yes?? Do they charge a fee? I'm assuming they do.

What was the reason for denial? Did you already appeal once? You stated they denied twice.

My surgeon and his office use MCRA. They are handling my case. They don't charge the surgeon or patient as I think they have incentive from the prosthetic company.

Kelly
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2004 MRI -cervical bone spur causing pain
2011 MRI -5 bulging discs at C3-7: Recommended C5-6 and C6-7 for a two level fusion, I said no thanks.
2014 MRI -progressive compression C5-7.
MRI 6/5/14- Ruptured L4-5, bulge at L2-3 and L5-S1 Dr recommends discectomy of L4-5 but won't do surgery until cervical is stable
8/2014- 8 months/3 rounds of appeals, Aetna denies 2 level cervical ADR
2 level ADR w/ mobi-c C5-7 Jan 7, 2015
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Old 06-15-2014, 07:29 PM
Iron Iron is offline
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Join Date: May 2014
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Yes Lindstrom is a advocacy group of lawyers who will represent me in my appeal. They do charge a fee.
I have been denied twice. I had my surgeon send an appeal after the first denial, only to be denied a second Time. Both times the denial reason was experimental surgery. Wow, how many of these things have been performed around the world to this date? I would bet hundreds of thousands .
Kelly, do you happen to know the prosthetic brand you are trying to have? Mine is Pro-disk C.
Thanks for the reply and good luck in your venture for better health.
__________________
Body Builder/Trainer
C5 Radiculopathy- with only major weakness in right bicep and deltoid, no pain. Unacceptable
Insurance denial of ADR
Grade 2+ spondylolesthesis at L5/S1 (I can deal with the pain as long as I am active)
May 8 2015----3 Level Cervical ADR @ C4-C5-C6
With Dr. Clavel
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  #4  
Old 06-15-2014, 08:15 PM
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Kelly4ADR Kelly4ADR is offline
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Join Date: Jan 2014
Posts: 259
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I'm on my last round appeal with Aetna for the mobi-c. I need a two level. Pro disc is made by Synthes, I would call them. I called LDR, the company that makes mobi-c. They put my surgeon in touch with MCRA to help with my case. They are getting a lot of positive outcomes for patients. I believe there are other companies out there as well that are helpful. Sometimes they want to go through your surgeon though, so if your Dr. Is willing, he could contact them as well.

Hope this helps!
__________________
2004 MRI -cervical bone spur causing pain
2011 MRI -5 bulging discs at C3-7: Recommended C5-6 and C6-7 for a two level fusion, I said no thanks.
2014 MRI -progressive compression C5-7.
MRI 6/5/14- Ruptured L4-5, bulge at L2-3 and L5-S1 Dr recommends discectomy of L4-5 but won't do surgery until cervical is stable
8/2014- 8 months/3 rounds of appeals, Aetna denies 2 level cervical ADR
2 level ADR w/ mobi-c C5-7 Jan 7, 2015
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  #5  
Old 06-15-2014, 09:30 PM
Iron Iron is offline
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Join Date: May 2014
Posts: 13
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Thanks Kelly. Good luck. I will keep my fingers crossed for you.
__________________
Body Builder/Trainer
C5 Radiculopathy- with only major weakness in right bicep and deltoid, no pain. Unacceptable
Insurance denial of ADR
Grade 2+ spondylolesthesis at L5/S1 (I can deal with the pain as long as I am active)
May 8 2015----3 Level Cervical ADR @ C4-C5-C6
With Dr. Clavel
Reply With Quote
  #6  
Old 06-17-2014, 10:35 PM
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Harrison Harrison is offline
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Join Date: Oct 2004
Posts: 7,010
Default Moving this to the Insurance Hell Forum

For better access and long-term searching.
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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
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