Get this.....
 

Aetna tells me they wont cover a Cervical discogram because it is experimental, yet, they cover lumbar Discograms and Cervical ADR's. Is that Nuts or what? You can bet Im going to appeal the hell outof that one and try to recover the $3,000 it will cost me to pay in cash.

Guess Ill be making use of Laurie Todd's book after all.

By the way, Im not sure how to appeal for coverage of a cervical discogram. At least with ADR appeals, you know what you are trying to prove. Not sure where to start with proving why they should cover a discogram(sigh)

Will Dr. Zigler do the ADR without a discogram? Usually it is the insurance that wants the discogram before approving the surgery. Doesn't make sense to me. I know that discograms aren't fail proof; but wouldn't even begin to understand why... Sorry, I'm not much help, Kathy

reply
 

Well, I guess I can ask. But then if I dont get it done, I wont have a chance for ADR approval? Weird situation huh. I guess I should feel fortunate enough if Aetna does approve the ADR.

Uggh, Steve this is ridiculous.

This is what happens when private insurance companies dictate medical care. It is absolutely ridiculous because they don't understand medicine at all just $$$$$ signs.

Good luck...

Got an idea...
 

Why not have dr. zigler try to get adr approval and see? If they say they want a discogram for adr approval, then you can use that denial to appeal the discogram denial and use their own reasoning against them.

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Excellent idea. Ill email dr ziglar's asst tommorrow and see whats going on. She will know if they usually require a discgram before ADR or not. It will help me with my appeal if I can find proof from other patients that Aetna required Discograms prior to ADR.

Something doesnt make sense. Again, if they call cervical discgrams experimental, then how are they approving cervical adr's? Ill see what going on tommorrow.