Pacificare?

[go*big*red]

Good morning!

I am waiting for my Dr. to get a preauth from my insurance co., Pacificare. Has anyone had any experience with them approving an ADR?

I'm almost to the point where I'll opt for a fusion (yet again) to try to address this pain which has been "stepped up 10 notches"

Just don't know if I can wait through the whole process. Anyone had to deal with them on this?

[go*big*red]

Denied.

Now on to the appeals process.

I have also been denied. I am in the appeals process.
I have heard that they have approved the ADR for some patients. Dr Regan's office has had some successes.

Mary

[Laura C]

I urge you to NOT give up. I am in the process of digitizing my appeal and will make it available to whoever needs it.

First and foremost, call or write to DePuy to get the appeals packet. It has an enormous amount of information along with guidelines for appeal. I used information from there as well.

On your denial letter, there should be some info as to what to do if you want to appeal the decision. Call or make an appointment with your doctor so that he can write a letter for the appeal. Remind him of anything that you would like stressed in his appeal letter. I made sure that my DR. stressed the fact that I have a broken bone that I was either born with or happened from a fall.

You must be persistant as the insurance co's knee jerk reaction is to deny. Keep following thru all of the processes.

Try to keep yourself comfortable in the meantime. If you do not have a pain management dr., get one. There is NO reason to be in pain. Also, make sure that your bed is comfortable - I just purchased a Tempur-pedic and it made a HUGE difference for me. Also, ICE, ICE, ICE!!! I hope that these few suggestions have helped. They give me some relief.

I will post all my info when it is ready - Good luck.

I am in the appeals process with Pacificare.
I would like to see someone's approval letter.
They have approved many ADR's with Dr Regan.
I don't know what's up. I just called for the appeals package with DuPuy.

[go*big*red]

My dr. is doing the appeals process for me - just did a letter with all accompanying medical reports, etc.

They have sent a power of attorney (of sorts) for me to sign and give to my dr. to allow him to act on my behalf.

Still waiting, but won't give up. In the mean time, am pursuing the possibility of some facet blocks to see if my facets are more involved than originally thought.

[go*big*red]

Grrrrrrrrrrrrrr After numerous calls to Pacificare regarding my appeals, after being told finally on 12/30 that because of the holidays that the appeal won't even be looked at until the first of January sometime (They recieved it on 12/21 and forwarded it to the "powers that be" on 12/22)

After calling yesterday being the squeeky wheel, they informed me that the appeal had infact been denied on 12/22!!!! Why the *&^#($*&) didn't they tell me that on 12/27, 28 or 30 when I called previously? And, how can someone make a determination on the quality of someone's life in a mere 1 day???

I AM SO ANGRY! Dr. P's office is calling them as they were never notified either, but Pacificare told me they were notified on the 22nd. Does any of this sound fishy to anyone other than me? What the (&)* is going on?

Sorry, just had to spew

Nope, doesn't sound fishy at all. It seems to be an automatic denial. they are not budging and at least in CA, the CA dept of insurance doesn't seem to want to force them to change their mind

GRRRRR is right! Sorry to hear of your latest obstacle. I hope Dr. Pettine's office has better luck. Too bad we can't have voodoo dolls to use and subject those insurance companies to some back pain. (Not that we'd wish that on anyone, but it may help them understand how we're feeling.)

[go*big*red]

Well LBP, you're exactly right. Apparently Pacificare is from CA because PC faxed a form to Pettine to send to the Insurance Commissioner of CA. So, that's the next step.

Hi, Mars. I'm really discouraged right now. Like I have the money to pay for the prosthetic! Anyway, I'm used to the new pain levels now so I guess I can wait a while longer. Once Prodisc is actually approved through FDA, then we might try again. I'm not sure how long we have to wait to try a preauth again.

Sometimes life just sucks. Not all the time - thankfully! I pray you're continuing to improve day by day. You're an inspiration. I just wish I were a candidate for the trials. Oh well....