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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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  #1  
Old 05-30-2008, 04:47 PM
April April is offline
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We are putting together an appeal, and I just read Laurie Todd's book. She recommends indicating specific cases where one's insurance company (or similar companies) haa approved the procedure. We would be grateful for any information regarding insurance cos that have approved this procedure. Any info regarding Unicare woud be especially useful. (The pdf under "ADR-friendly Insurance includes info up to Sept 2006, but it would be helpful to hear of more recent approvals. )

April
Husband w/DDD, needs ADR at one level and fusion at another.
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  #2  
Old 05-31-2008, 12:06 PM
mmarsh mmarsh is offline
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April

Contact the manufacturer of the disc your surgeon wants to use and ask them which companies are covering the use of their disc. They have some basic info that you can use. Find any and all precedent you can by surfing the websites. There is some info available but it's not easy to find. Find studies and articles written by doctors that support your side. Best of luck to you.

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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  #3  
Old 05-31-2008, 01:19 PM
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Terry Terry is offline
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My 4-level ADR surgery done November 4, 2006 was covered by Blue Cross/Blue Shield of Michigan January 2007. I did not have to file any appeals, etc. and consider myself to be extremely lucky.

Best of luck to you.

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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  #4  
Old 05-31-2008, 07:07 PM
April April is offline
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Thanks for the suggestions. I think we now have nearly all of the info we will need (including many peer-reviewed articles). Thanks so much for the help!
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  #5  
Old 06-01-2008, 07:35 AM
LBP LBP is offline
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my 2 level lumbar Prodisc on 4/7/08 was paid by Aetna Medicare.
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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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  #6  
Old 06-05-2008, 04:05 PM
Mi Mi is offline
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I am currently looking into insurance companies that will cover ADR (Active L). I live in California and may be getting a new job soon and I need to choose health insurance. Right now I have BCBS, and they will not cover ADR. Does anyone have any suggestions? I plan to go to Stenum HOspital in a few months to have my L4-L5 replaced. Thanks!
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  #7  
Old 06-12-2008, 02:20 PM
LBP LBP is offline
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have you read everything on this website about stenum before making the final decision to go there?

You want to get Aetna insurance and there are several very good surgeons in southern california who can perform lumbar Prodisc surgery.
__________________
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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  #8  
Old 06-16-2008, 10:16 AM
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Terry Terry is offline
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If you really would like to go to Stenum Hospital please contact me as I was an actual patient there. I always get concerned about contempt prior to investigation. An example is; "My brother knew a guy whose best friend had somebody who went there and they amputated their left leg by accident." I got fabulous care there as did several others who've posted here and I am sure they have had some complications as well. It would be nice if you got totally informed about all surgeons before you decide. I would also be cautious about surgeons who; "Cherry Pick" their patients to inflate their outcomes. It makes them seem God-Like when they have set it up to work on the cream of the crop.

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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