Insurance Coverage Poll
 

Please vote in the poll above.

Oops. :o I should have added the option:

"No, denied based on 'experimental' status AND paid out of pocket in US or Overseas."

This fits my situation better: I was denied coverage, appealed, lost and subsequently went to Germany and paid out of pocket for my surgery.

Yes but it's Worker's Comp. I did alot of work getting it done though by pestering the insurance co. and my employers medical director. I did enough information gathering beforehand that I had enough ammo to take on the insurance co.

In 2002 BC/BS simply denied my multi-level ADR and never thought I had a snowballs chance in hell... never appealed. They did pay $1000 for my brace though.

At the time, my 2-level lumbar ADR cost 22K Euros, which cost $22K. Not like today!

Mark

I have more than one answer that fits.. I answered 'insurance denied as experimental' I did appeal and was denied again, then gave up on insurance and entered a clinical trial. Surgery in March! Yeah

Posted under "other".

Mine is a little unusual but shows what you can do when you put your mind to it and can think a little through the pain.

BC denied as "experimental" and "investigational". Surgery approved on surgery day, and then denied as "experimental" and "investigational" therefore not "medically necessary".
Appealed to hospital after they went after BC and weren't successful, and hospital charges were "forgiven".
However, still have surgeon fees and outrageous co-pays and regular payments. But I didn't have to mortgage our retirement as my husband and I were prepared to do.

Don't give up the faith because I certainly believe when there is a will there is a way. Maybe insurance didn't think i would go through with surgery and therefore approved it, thinking they would just deny it after the fact. I don't know. I didn't find out that they had actually approved my ADR surgery until the hospital told me several weeks later. I found out that if insurance hadn't approved surgery, I would not have been able to have it.
Food for thought for those fighting insurance companies. As some of you know, I fought extremely hard against BC and made a big stink.

I just figure someone is looking out for me and I am happy to have the ADR and not fusion.

runner

Count me too as "other". In 2002 BC/BS of NY authorized a two-level ADR with Dr. Regan. I declined surgery.

Now, they and BC of CA will most definitely decline any ADR. Those were the daze.

Justin,

You could add another: Yes, but only by gunpoint.

I'll let you know if it works.....:D

I must be a rarity in getting mine covered. I had a lawsuit against the homeowner whose dog took me out on my bicycle. I also had been denied twice from BC/BS prior to the surgery and was anticipating getting my surgery reimbursed from the proceeds of the lawsuit. BC/BS had a lien against my lawsuit as well because they had paid close to $30,000 towards my care since the accident occurred. We went in to mediation within two weeks after coming back from my 4 level ADR surgery. We won the opportunity to have all of my expenses paid including having my lien settled with BC/BS. A month after all was said and done BC/BS came along and reimbursed us for the entire cost of the surgery done in Germany. I got close to $62,000 back from them and have been in awe of them ever since. They are awesome in my book. I am hoping that this becomes traditionally paid instead of being the opposite in the future.

Terry Newton

As of yesterday insurance approved mine but only after 4 denials and getting my company, which is self insured, involved. My company was great. All employers should treat their employees the way my company does.

It is important to note that the insurance information provided here is mostly for the artificial disc replacement and for patients trying to get reimbursement on their own.
However, Prof. Dr. Bertagnoli does many types of complexspine surgery. Indeed he takes many severe cases, which no other doctor will. He has even replaced the entire lumbar spine of a patient! These cases need the TPAs ever more so than the ADR patients.