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Insurance Issues Discuss Insurance Coverage Poll in the Main forums forums; Please vote in the poll above....

View Poll Results: Did insurance in the US pay for your ADR surgery?
Yes, without any appeal(s) 3 16.67%
Yes, only after appeal(s) 2 11.11%
No, denied based on "experimental" status 5 27.78%
No, subsequently pursed fusion on ADR coverage denial 1 5.56%
"Gave up" on insurance coverage -- paid out of pocket in US 1 5.56%
"Gave up" on insurance coverage -- paid out of pocket Overseas 2 11.11%
Covered as a compassionate case or involved with Clinical Trial 0 0%
Other -- Please comment below 4 22.22%
Voters: 18. You may not vote on this poll

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  #1 (permalink)  
Old 01-31-2009, 05:27 PM
Justin's Avatar
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Default Insurance Coverage Poll

Please vote in the poll above.
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-Justin
1994 Football Injury
1997 Snow Skiing Injury
Laminotomy L4/L5 (3.7.97--17 years old)
1999 & 2003 MVA (not at fault both times)
Grade V Tears L4/L5 & L5/L6
2-Level ProDisc® L4/L5 & L5/L6* *lumbosacral transitional vertebra (11.15.03--23 years old)
Dr. Rudolf Bertagnoli -- dr-bertagnoli.com
Pain-free for the last 4.5 yrs.
5.14.09 DSS with Dr. B.
I'm here to help. Only checking PMs currently.
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Old 01-31-2009, 06:16 PM
Justin's Avatar
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Oops. 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.
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-Justin
1994 Football Injury
1997 Snow Skiing Injury
Laminotomy L4/L5 (3.7.97--17 years old)
1999 & 2003 MVA (not at fault both times)
Grade V Tears L4/L5 & L5/L6
2-Level ProDisc® L4/L5 & L5/L6* *lumbosacral transitional vertebra (11.15.03--23 years old)
Dr. Rudolf Bertagnoli -- dr-bertagnoli.com
Pain-free for the last 4.5 yrs.
5.14.09 DSS with Dr. B.
I'm here to help. Only checking PMs currently.
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Old 02-04-2009, 05:55 PM
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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.
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12/16/03 Work Accident
Herniation and DDD at L4-L5
4/1/05 Discectomy
Epidurals and facet injections
5/15/06 Discogram confirmed L4-L5 DDD also an asymptomatic L5-S1 tear
10/24/06 L4-L5 Prodisc surgery with Dr. Goldstein
CAT scans & X-Rays show ossification
Trigger Point Injections, Medial Branch Blocks, Acupuncture, Weekly Deep Tissue Massage
10/27/08 Discogram (positive L5-S1)
11/25/08 L5-S1 fusion with Dr. Goldstein
FAILED BACK SYNDROME
Liberty Mutual WC
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Old 02-05-2009, 01:21 AM
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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
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1997 MVA
2000 L4-5 Microdiscectomy/laminotomy
2001 L5-S1 Micro-d/lami
2002 L4-S1 Charite' ADR - SUCCESS!
2009 C3-C4, C5-C6-C7, T1-T2 ProDisc-C Nova
Summer 2009, more bad thoracic discs!
Life After Surgery Website
President: Global Patient Network, Inc.
Founder: www.iSpine.org
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Old 02-05-2009, 02:12 AM
Kathy's Avatar
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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
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34 years old-
1/06- In wreck with 18 wheeler
Numerous MRI's, PT, chiropractic, accupuncture, TENS therapy, massage therapy, facet injections, epidural injections, Nerve study, Discogram, confirms pain in L4/5, IDET, decompression, Bi-lateral neurotomy L3/4/5, denied by insurance twice, in Active L clinical trial, had surgery March 17, 2009 in Miami, FL- received Active L disc
Had Baby #3 after ADR!
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Old 02-06-2009, 11:43 PM
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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
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Old 02-28-2009, 01:26 AM
ans ans is offline
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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.
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Old 02-28-2009, 04:14 AM
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Location: Douglasville, GA
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Justin,

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

I'll let you know if it works.....
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04/06 L5/S1 Rupture
05/06 MRI shows DDD @ L2-S1
06/06 Diskectomy/ Laminotomy L5/S1
04/07 Recurrent Disc Surgery L5/S1
3 Ortho and 1 Neuro Surgeon, 3 MRIs, 1 EGM, 1 Myleogram & 11 EDIs later:
03/27/09 Maverick ADR at L4/L5 & L5/S1
03/27/09 The Lord and Dr. Ritter-Lang returned my life to me.
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Old 03-01-2009, 02:45 AM
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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
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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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Old 04-02-2009, 12:50 AM
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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.
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Pain since Sept 97
Diagnosed DDD at C5/6 June 07
Insurance finally approved 3/31/09!
Waiting on Bryan disc approval
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Old 02-19-2011, 08:26 AM
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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.
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