Got my answer to my insurance appeal...

[Kathy]

Thank you Mark, I will look up the articles I have and let you know, so I can get the newer ones. I thought that it was odd that they used only one article and an old one at that. I think I will just order Laurie Todd's book, so I can get to reading and preparing to fight. Thanks again and thanks for this great site.
Kathy

[steve55]

Kathy, the Spinehealth mesage board was where I got the most replies when I asked for people to message me who have approval letters for ADR. Post the question on every board you know. But title it someting that has a call to action like" Need help-Lumbar ADR approvals, pls respond" . I would also post it in the "Insurance" sections of these back boards. And, to be sure your post doesnt sink to low on some of the boards due to last reply date sending it to the back of the line, you might reply to your own post every once in a while with a "thanks everyone" ,to bring it back to the top. Many people dont click back to far in date. In a matter of days I had 3 or 4 people who not only had their approval to send to me, but said they could share other approvals they collected for their own cases. Imagine showing them 20-30 approvals by various insurance carriers, and if you are lucky enough, maybe you will find a Unicare one that slipped thorugh their cracks. But follow Laurie todd's advice, she knows their weak spots and thats what will matter most in the end. Hey, if you got time on your hands, or dont have much else to do (due to not going out as much due to pain) this battle may give you some sense of purpose or something to work towards for the time being. You may as well give them hell since they are more than willing to give the same to you by their unwillingness to approve your ADR.

[ans]

I'm sorry to hear this. Maybe if you email Laurie she might have some inside information; she's a great person.

health insurance help

My best - ans

[treefrog]

Sorry to hear about the denial Kathy.

After reading all the advice here, I am encouraged. I had not even thought about applying to have my insurance company pay (BCBS of NC). I had just accepted that I would have to pay the $8000 (for the disc and supplies needed for that part of the surgery, since I was looking at hybrid surgery), if I chose to go that route. It would be great if I could get them to pay.

[Kathy]

Originally Posted by treefrog

Sorry to hear about the denial Kathy.

After reading all the advice here, I am encouraged. I had not even thought about applying to have my insurance company pay (BCBS of NC). I had just accepted that I would have to pay the $8000 (for the disc and supplies needed for that part of the surgery, since I was looking at hybrid surgery), if I chose to go that route. It would be great if I could get them to pay.

I am pretty sure that I have heard of BCBS paying for ADR. I think that is what Terry has that paid for his and he is in Michigan; he had surgery in Germany and got it paid for. You might pm him to make sure my information is correct.

[Roblin]

Kathy,
I'm so very sorry to hear of your denial. Stay strong and fight this thing. You are a winner! I'm sure you will get all of the ammunition you need to fight and win.
Sincerely,
Roblin

[shamsuthbegum]

I think you have more spirit so you can lead your life luxuriously.....
.............

[Maria]

In terms of adjacent level syndrome if it were fusion that were being suggested it would probably authorized and that in itself seems to have much evidence of necessity for further surgery re adjacent level problems not to mention revision surgeries.. yet because it's tried and true and been around for so long no doubt it would be authorized.

Sorry to read about the denial and hopefully it will be authorized soon. I hope you don't have to wait too long because as someone who has waited around a long time for me likey the option of ADR is out the window now because of the number of years I've waited and continued degenerative process in my spine re endplates and facets...adjacent level probs that occur anyway with no surgical intervention.

That part about being young ~ that should bode well for you in terms of recovery and that much is probably in the literature as well in terms of any surgery.

[takidenza]

In 2008 we were in a severe car accident and subsequently my wife has developed neck problems. After a Disco gram, the doctors suggested an Artificial Cervical Disc surgery. Unfortunately, everybody but our insurance (UHC) approves of this. She doesn't want to have surgery at all, but she doesn't want to have any more pain. What do I do? How do I appeal this? I feel bad for my wife and want to help her in the best way I can, and everything points to this being the best option for her. Please help us?

douglasp@mac.com

[mmglobal]

Sadly, the state of health-care in the US allows our insurance companies to deny coverage for something that has been studied and FDA approved, saying "it's experimental" - even though it's not. There is an appeal process and some have been successful, but for the intractible insurance companies, it feels like we are tilting at windmills.

Good luck... let us know how it goes.

Mark