Help with approval ltrs and finding studies for my appeal

[chasswen]

heres a great site for papers written by doctors just search link is for bertagnoli.
Bertagnoli,R
chuck

[steve55]

Thanks to all who replied. It's a starting point.

[treefrog]

I knew there was a paper that I had seen in the articles section of this forum, that compares cost of fusion with ADR. It is for single level, but I would think it would transfer to multi-level. At least it is a starting place.

Here is the thread.

An economic model of one-level lumbar arthroplasty versus fusion

But let me know if you can't pull up the paper. I can save it in PDF, and email it to you, if need be.

[Katie]

treefrog, that is a very good article. Is there any that give actual cost in dollars and cents? I know that is hard, with the costs being scattered between the hospital departments, etc. It took a long time to find that for up here.

The ironic part is that the report also states, along with almost every other publication I've found, that the reason they are not doing more ADRs is because of costs....even though their other own government department proves that it is instead cheaper, not more expensive. I suspect they mean that they can not afford all the training, etc. Short sightedness again.....

Have you had any more luck with this, Steve?

[steve55]

Yes, The best tool is using pubmed. The people at spine journal said the pubmed website pulls of all their studies as well as others, and its free. It just pulls of a basic overview with the conclusion of the stufy. Heck, thats perfect for me as I will highlite the conclusions to prove my points.

Havent been able to find any articles comparing the costs but am having my Dr ziglar folks work up a estimate with codes for what a 3 level fusion would have cost (incl hospital bill estimate).

The insurance warriror talks about pulling up 100 peer reviewed studies but there just arent that many out there so Ill end up submitting around 25 to 30 I think. Sure wish I had more Aetna approval letters as this is the biggest weapon at getting approvals.

I plan to take them to court if necessary as long as the atty is willing to take me on with a $$ cap. I can maybe pay $2-$3K fee and also be willing to fork over a portion of the reimbursement or something to get a attorney to help me. One way or another, Ill fight like hell to the bitter end and be a thorn in their side just for the sake of PRINCIPAL. Ive paid my insurance dues and I deserve to be reimbursed for a service Ive paid for all these years.

Im following Laurie Todd's advice to a tee and Ill call her or email her if if necessary to get the Aetna insider ph and fax# if necessary. Im a bulldog when it comes to matters of injustice. Ive fullfilled my end of the contract/obligation by paying their dues all these years and now I expect them to fulfill theirs.

[Terry Allen Blackburn]

Good for you Steve. I hope everything works out for you.

Terry Newton

[chasswen]

sorry to say this but it's true. one can't sue a non-for profit insurance company for any more then the act costs of the surgery. no travel or lawyer fees etc...
been there done that with blue crap.
chuck