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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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  #41  
Old 03-01-2008, 12:47 PM
Cathyjp Cathyjp is offline
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Join Date: Aug 2007
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Hi,
New to site and my husband was also denied a 2 level adr by Fiser V health.

Just learned that our insurance will be switching to UHC and was wondering if anyone had any new information on this insurance?
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  #42  
Old 03-08-2008, 03:35 PM
sahuaro sahuaro is offline
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Join Date: May 2005
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Sadly, I have to add myself to this list. Denied for one-level Prestige ST by HealthNet of Arizona. Appeal went all the way through the Department of Insurance. The reviewer stated that the Prestige is "one of several artificial disks not proved effective." Meanwhile, HealthNet in California has been approving the Prestige ST.
__________________
2001 MVA; C5-C6 disk extruded
ongoing physical therapy, exercise and massage
ESI's, oral prednisone, trigger point injections
foraminal and central stenosis C5/C6 and c6/C7
2007 EMG/nerve conduction shows pattern of chronic radiculopathy
January, 2008: Prestige ST Artificial Disk Replacement, C5/6
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  #43  
Old 03-12-2008, 06:29 AM
snapoutofit snapoutofit is offline
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Join Date: Oct 2007
Posts: 31
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Yep, add me too. I was denied by United Health Care. We are still appealing but really just doing it to go through the motions - not expecting anything. I live in Charlotte, NC and paid out of pocket (46K) not including air,hotel etc. for a 2 level l4-s1 with Dr. B.

Cheryl
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40 yrs mother of 3
Feb 2005 woke up and out of the blue couldn't walk.
DDD L4/L5/S1
Feb 2008 Prodisc L4-S1 Dr. B, Straubing Germany - SUCCESS
Now I have cervical pain, heading down the same path
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  #44  
Old 03-12-2008, 12:02 PM
Terry's Avatar
Terry Terry is offline
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Posts: 1,210
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The Prestige is being labeled by the insurance company as not being effective.

Oh my God. I have two in my neck that are doing great. I better rip them out before they become ineffective.

I am sorry.

Terry Newton
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1980 ruptured L4-L5
1988 ruptured SI-L5
1990 ruptured C5-C6
1994 ruptured C6-C7
1995 Hemi-Laminectomy C5-C6, C6-C7 Mayo Clinic
Bicycle Accident 2004
MRI, EMG, Facet Injections, Epidural Blocks, Lumbar Discogram.
Stenum Hospital Surgery November 4, 2006
Prestige Disc C5-C6, C6-C7
Maverick Disc S1-L5, L4-L5
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  #45  
Old 03-27-2008, 11:07 AM
mmarsh mmarsh is offline
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I've been denied a one level ProDisc-C by Blue Shield of CA. Am in the first appeal. Looking for people who have been approved to add to my appeal "precedent". Anybody out there who got approved?

Missy
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fusion L4-5, Dynesys rods L3-4, fusion c5-6 and C6-7, current problem C-7/T-1
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  #46  
Old 04-28-2008, 12:38 PM
ChainedJane ChainedJane is offline
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CIGNA denied my single level Presige ADR and I have no other spine health issue besides the one herniated c/6-c/7 disc. I live in Kansas City, MO and have CIGNA group health through hubbies work. The denial came literally as I was going into the operating room. Family had flown in and so fourth =(.My doc is awesome and sent in the appeal the very next day, I reported CIGNA to the insurance commision and also am consulting a lawyer. We are going to fight them till the end!

Does anyone here know where I can find out if Cigna has covered any aype of ADR? I have looked forever!

Thanks for any info!
Janey
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*c/6-c/7 herniated disc /pinching nerve causing extreme and radiating pain in back-neck and nubness in left arm and compressing spinal cord from 13mm to 6 mm- cervical steriod injections-physical therapy-lots of meds-*

CIGNA insurance revoked my F
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  #47  
Old 04-28-2008, 03:41 PM
LBP LBP is offline
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Janey,

Have you done an "advanced search" of all forums using both "Cigna approved" ?

There was some older discussion by Bmills that she knew of 1 or 2 poeple that had Cigna Open Access in Colorado that were covered for ADR and I believe there was a post by Harrison that on the Depuy Charite website, it was announced that Cigna would cover ADR? Maybe they once did and now retracted? worth looking at Charite's website on the ins reimbursement info to see what companies they listed as covery adr.

good luck
__________________
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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  #48  
Old 04-28-2008, 04:27 PM
mmarsh mmarsh is offline
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Janey

I checked my notes and Cigna is authorizing Prodisc. Look at the Synthes web site and you will find a number for patient support. Call them and get info regarding Cigna's authorization. Has the Prestige been okayed by the FDA yet? Good luck (again).

Missy
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fusion L4-5, Dynesys rods L3-4, fusion c5-6 and C6-7, current problem C-7/T-1
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  #49  
Old 04-29-2008, 01:42 PM
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Terry Terry is offline
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Prestige has been approved for one level cervical by the FDA at this point. There have been some surgeries take place in the US so far.

Terry Newton
__________________
1980 ruptured L4-L5
1988 ruptured SI-L5
1990 ruptured C5-C6
1994 ruptured C6-C7
1995 Hemi-Laminectomy C5-C6, C6-C7 Mayo Clinic
Bicycle Accident 2004
MRI, EMG, Facet Injections, Epidural Blocks, Lumbar Discogram.
Stenum Hospital Surgery November 4, 2006
Prestige Disc C5-C6, C6-C7
Maverick Disc S1-L5, L4-L5
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  #50  
Old 05-05-2008, 05:05 PM
ChainedJane ChainedJane is offline
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Thanks for all the info I will dig into all the suggestions!!
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*c/6-c/7 herniated disc /pinching nerve causing extreme and radiating pain in back-neck and nubness in left arm and compressing spinal cord from 13mm to 6 mm- cervical steriod injections-physical therapy-lots of meds-*

CIGNA insurance revoked my F
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