Got my answer to my insurance appeal...

takidenza · #1 (**permalink**) 04-28-2010, 04:06 AM

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 · #2 (**permalink**) 04-28-2010, 11:33 PM

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

dshobbies · #3 (**permalink**) 04-29-2010, 06:12 PM

takidenza,

Welcome to the forum. I'm sorry your wife's pain is great enough to require intervention.

Much more often than not, insurance companies are denying ADR coverage with only a few successful appeals. Most of us who had this surgery had to pay on our own and many of us went to Germany for the best surgeons- Drs Bertagnoli and Zeegers. The cost is half the price vs the cash price here in the US. I sometimes wonder if doctors and hospitals realize how much business they're losing to other parts of the world?

Anyway, please start a new post and tell us her story - or have her tell it herself. We're here to help.

Dale