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Insurance Issues Discuss BCBS World in the Main forums forums; I have BCBS and just had 2 level lumbar ADR surgery in Bonn Germany with Dr Zeegers and I have ...

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  #1 (permalink)  
Old 04-24-2014, 01:36 PM
henry4956's Avatar
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Location: Connecticut, USA
Posts: 48
Default BCBS World

I have BCBS and just had 2 level lumbar ADR surgery in Bonn Germany with Dr Zeegers and I have friend who had exact same surgery with Dr Clavel in Spain 4 months ago. My friend recently informed me that BCBS world has compensated him for EVERYTHING except a $500 deductible and the hotel fee.

The key I believe is not submitting through the normal channels and finding the number for BCBS WORLD. Anyone who has BCBS and has recently had or is contemplating adr surgery should be excited!
__________________
2001 bad fall on ice playing hockey
Apr 2001 lami/discectomy L4/L5 (large rupture)
Aug 2001 lami/discectomy L5/S1
Coccyx dislocated / same fall (Cannot sit)
Aug 2011 pull-start generator - unrelenting low back pain - can only stand for 30 min
Nov 2011 -rhizotomy - makes things worse
22 hours/day in bed
June 2012 - present receiving facet injections every 4 months, only last one helped somewhat
L3-L5 ActivL Surgery w/Dr Zeegers April 16th
Doing great!!!!!
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Old 04-30-2014, 05:19 PM
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Join Date: Apr 2014
Location: Aurora, Oregon 97002
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Default BCBS World

Hi henry4956,
Have you submitted your claim to BCBS yet? Does your policy have specific language that states international services are covered? Did BCBS know that you were going to Germany for the sugery?
The answer to these questions is extremely important by what the answer is.
If BCBS has no exclusions for surgery overseas and they didnt require authorization or to know ahead of time about the surgery then you might have a chance to recoup your money.
Are you familiar with submitting claims for reimbursement for services?

Would love to help.
Odie
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Old 07-09-2014, 07:33 PM
vnf vnf is offline
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Location: Florida
Posts: 43
Default same issue

Henry

I have BCBS too.
I wonder if I can get any of my surgery covered?
Let me know if you get anything worked out.
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Old 07-10-2014, 06:48 PM
mmglobal's Avatar
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Posts: 2,511
Default

Vicki, welcome to the forum. You might want to send Henry a private email and ask him to update this thread.

Good luck!

Mark
__________________
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 07-12-2014, 04:12 AM
vnf vnf is offline
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Location: Florida
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Default Thanks Mark

Thanks Mark and we have chatted by phone
Henry makes for a good shoulder!
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Old 08-11-2014, 04:06 AM
henry4956's Avatar
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Join Date: Jan 2014
Location: Connecticut, USA
Posts: 48
Default Not looking good

I really had my hopes up when a BCBS WW rep called me about a month ago. He needed for me to have one document that was not legible resubmitted. This made me think, they are working on it - so that's good.

2 weeks ago I contacted BCBS RI and referred to my case # and was told all that was missing was a pre-auth or letter of medical necessity. Even if it was after the fact it would be OK. I created a draft and Dr Zeegers filled in the rest. I submitted it and about a week or so later they tell me it has been denied. I was told it would only be paid for if the surgery was an emergency and not planned in advance.

My wife just so happens to work for the man at RI Hospital who is the head guy for all things BCBS related. Her co-workers have told her he has the authority to make a call (pull a few strings) and I would get reimbursement.

At this point it seems that is my only chance. So far we have been trying to do this thing by going thru all the proper channels and it has gotten us nowhere.

How are you doing Vicki?
__________________
2001 bad fall on ice playing hockey
Apr 2001 lami/discectomy L4/L5 (large rupture)
Aug 2001 lami/discectomy L5/S1
Coccyx dislocated / same fall (Cannot sit)
Aug 2011 pull-start generator - unrelenting low back pain - can only stand for 30 min
Nov 2011 -rhizotomy - makes things worse
22 hours/day in bed
June 2012 - present receiving facet injections every 4 months, only last one helped somewhat
L3-L5 ActivL Surgery w/Dr Zeegers April 16th
Doing great!!!!!
Reply With Quote
  #7 (permalink)  
Old 08-18-2014, 04:32 AM
vnf vnf is offline
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Join Date: Jul 2014
Location: Florida
Posts: 43
Default Hangin

Henry

I'm hangin in there
Going today for SI joint injections since I have alot of pain in the tailbone area.
Probably referred pain from the L5 level but going to give the shots a try.
Thanks for asking

My BCBS says that I have benefits and gave me a case # too.
Haven't submitted a pre auth letter and will probably get the same
bs you got! I hate insurance companies.
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