ADR Paid For? Email Me

[Researcher]

After looking at some other successful ADR appeal documents, I decided to modify the precedent information slightly to improve the quality of the information. Here's the revised format. Please aim anyone you know that got their ADR paid for by insurance my way. If SPS members, they can use PM. If not, they can use adrpaidfor@comcast.net. Those SPS members that have already responded, please send me an update.

John Smith (surgery date: 09/22/2006)
Diagnosis: Degenerative disc disease C4/5, C5/6, C6/7, Herniated disc L4/5 and L5/S1
Treatment: 3-level cervical artificial disc replacement, 2-level lumbar disc replacement
BCBS of Anystate paid Dr. Clickenneck, Hurtenbody Hospital

Thanks,

Phil

[Researcher]

I have been digging for precedents for about a month now. Finally, today, I found the golden precedent. What's a golden precedent, you say? It's the patient you find that lives in the same state you live in, has the same insurance company you have, had ADR surgery, and the insurance company paid for it! Now I can say, "Mr. Big Bucks insurance company. All I'm asking is that you give me the same fine level of care and service that you offered Mrs. Fineback here a few years ago. She had DDD. So do I. She got multi-level ADR. That's all I'm asking for. She went to Europe for surgery. That's what I want. Surely you'll be my cross and my shield like you were for her! I know that you will remain focused on the one corporate goal you've had since 1936: to provide the best health care coverage in a caring and ethical manner. Oh, yes! i know you will."

Besides my golden precedent, I am up to 33 others, 24 of which are patients with other BCBS companies. This will make writing the rest of the appeal more fun.

Phil

[Santorini]

So happy to hear your progress and thrilled that others have stepped up and provided you with the information you need!!!

[KanRunMo]

Be sure and put your final appeal document on SpinePatientsociety.org website. I suppose it should be in the insurance section but I'd like to see it on the forum also. It will be great to hear if it gets them to pay for your surgery. I would definitely like to do the same thing, multi-level ADRs. Best of Luck. Where are you headed for your surgery?

[runagain]

Researcher,

I had 59 plus people on my last appeal. Not to brag, but it did not help me. I think sometimes things help and other times, the insurance company does not care.
On my first surgery, I had a friend who had the same surgery, same level. close to the same date and we had the same adjuster. They agreed to pay for her surgery and they denied mine from here to New York.
I told them about her and they invoked the HIPPA law (I had a copy of the approval letter). Cannot talk to this person or about her. We look at each individual case and she might have had something different.
We were near twins. I kept asking them, "How can you say my surgery/device is "experimental" and hers is not?"
I have found out one thing: Insurance companies do not make sense.
Despite all this, I encourage you to keep trying. I think they may more readily pay for an out-of-country surgery.

Good luck,

R