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Insurance Issues Discuss List of Insurers Approving ADR Surgery in the Main forums forums; If your insurance paid for your ADR surgery, please post the name / state of your insurer in this thread. Hopefully, ...

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  #1 (permalink)  
Old 01-31-2009, 07:08 PM
Justin's Avatar
Senior Member
Join Date: Apr 2007
Location: Philadelphia
Posts: 303
Default List of Insurers Approving ADR Surgery

If your insurance paid for your ADR surgery, please post the name / state of your insurer in this thread.

Hopefully, this info will be helpful for those contemplating ADR surgery.
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 02-03-2009, 02:58 AM
Join Date: Oct 2007
Posts: 35
Default First Choice Health in Washington State

My surgeon and I had to appeal my case twice before getting approval. I had 3 level (Prodisc C). Insurance agreed to pay for hospital, surgeon and one implant. We are still negotiating who is going to pay for 2 of the implants. Dr. Jens Chapman from University of Washington Medical Center was amazingly helpful. He wrote letters of appeal on my behalf and encouraged me to not give up. I came close to going to Germany and/or paying for the surgery myself here in the U.S. Either of those choices would have meant cashing in our retirement or refinancing our home. It took a lot of time and energy to get the insurance company to agree to pay for anything. I felt like I had a second job! I talked to and emailed my H.R. department, staff attorneys with the attorney general's office, and anyone else I thought might be able to help me. In the end it paid off, but there were many months that it seemed like my efforts were futile.
12/29/08- 3 level ADR Prodisc C in Seattle
12/21/07-Revision surgery, fusion L4/5 L5-S1
1975-scoliosis surgery,Harrington Rods, fused T2 to L4
Felt great in 20's and 30's....late 30's started having chronic neck and lower back pain. By 40 pain worsened enough to begin seeking surgical solutions.

ADR surgery much easier recovery than fusion!
This site has been a great source of information for me! I would be happy to help anyone who has questions.
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  #3 (permalink)  
Old 02-03-2009, 04:11 PM
Join Date: Oct 2008
Location: Longview, TX
Posts: 68

At first my insurance considered ADR experimental. The Surgeon appealed and was told that UHC was going to approve ADR in about 6 months. I was tired of waiting and started seeing another surgeon for a fusion. (First Surgeon never offered fusion) I finally got a call that the ADR was approved. I have decided to stick with the fusion since it is L5/S1 and Facet concerns. So, UHC must be approving the ADR surgery now.
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Old 02-03-2009, 10:21 PM
Senior Member
Join Date: Jan 2009
Location: Harbor Springs, Michigan
Posts: 211

I have Blue Cross of Michigan. They paid the full amount for my four level ADR surgery done at Stenum Hospital on November 4th, 2006. The amount was close to $61,000. I sure was grateful. They have taken excellent care of me and my employees. I ensure almost 32 employees.

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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Old 04-08-2009, 10:17 AM
ans ans is offline
Senior Member
Join Date: Oct 2006
Posts: 362

Wow, Terry. That is fantastic. I have BC and BCBS whom I hear in CA at least w/be the last holdouts - 'tho in '02 they were wiling to pay for a two level ADR that I chickened out of. Best to you. - Allan
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Old 05-01-2009, 07:24 PM
Join Date: May 2009
Location: Southern Indiana
Posts: 40

If anyone has any details they wouldn't mind sending me, please do... I'm new to the forum, but starting to build up all my research for my appeal when I need to submit it. I haven't had it submitted to insurance yet to have it denied, but I go to the Dr the 11th, so I'm sure it will be soon. I'm looking for any appeals that were won.

My e-mail is rblunk@insightbb.com
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  #7 (permalink)  
Old 05-09-2009, 12:15 AM
Senior Member
Join Date: May 2009
Posts: 100

I know this thread is older......Terry Allen, no disrespect but you were probably covered because you ensure your employees with BCBS. If they were to deny you they would risk losing your business.
Chiari 1 malformation - successful surgery 1-22-09
C5-6 herniation (extrusion) with moderate central canal stenosis and bilateral foraminal stenosis.
Prodisc-C @ C5-6 surgery on 5/28/09
VATS thoracic fusion @ T3-4 and T6-7 on 9/11/09
Fusion w/cage @ C7-T1 on 11/12/09
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Old 05-03-2011, 02:37 AM
Junior Member
Join Date: Jul 2010
Location: Portland, OR
Posts: 1
Default Victory!!!

After dealing with my insurance for almost a year, they have finally agreed to pay for my ADR.
I had the surgery in June '10. I agreed to pay out of pocket for it, but after the surgery filled my 4th appeal.
My insurance had made many mistakes along the way in the denial process and we made sure to highlight every.single.mistake.
We tore apart the medical policy. They told us that it had to go to an IRO. We made sure they sent everything. All medical records, all denials and our 44 page appeal we wrote.
IRO approved it!!! But that was not the final victory. Lifewise did not have to agree to abide by the decision.
Today I called, after they failed to return 3 other phone calls, and said yes, they would honor the decision and will start processing bills in the next few weeks.
Not only did we write a great appeal, but we kept record of the phone calls, all emails, all mistakes and anything else that would help us build a case. When our insurance company wouldn't do things properly we would quote Oregon state law in emails to them. I think they thought we had a lawyer.

Anyways, I live in Oregon. We have Lifewise, which is also known as Premera in other states. From all the research we found we are one of the first lumbar ADR's to be approved. We did find a Cervical that they had done a year or so ago.
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Old 05-03-2011, 04:19 AM
mmglobal's Avatar
Join Date: Sep 2006
Posts: 2,511

Amy, what great news!!! Thanks for posting. I have felt that fighting the insurance companies was tilting at windmills, but the more recent successes will give many of us hope!!!

Thank you!!!! Great job.

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 05-03-2011, 05:45 PM
dshobbies's Avatar
Senior Member
Join Date: Oct 2006
Location: Los Angeles
Posts: 1,596

2 thumbs up. Your perseverance pain off. Good for you!
3 level Prodisc adr S1-L3, Oct 12, 2005
Dr. B in Bogen, Germany
Severe nerve damage in left leg, still working on it
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  #11 (permalink)  
Old 06-14-2012, 01:35 AM
Junior Member
Join Date: Jun 2012
Posts: 1

I have been discussing it with my insurance company for quite some time now. hope we resolve this sooner.
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