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Any specific information re Anthem BC of CA?

This is a discussion on Any specific information re Anthem BC of CA? within the Health Insurance forums, part of the Insurance and Travel Forums category; I am in an unusual situation with regard to insurance. I used to be insured with Anthem Blue Cross of ...

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    Default Any specific information re Anthem BC of CA?

    I am in an unusual situation with regard to insurance. I used to be insured with Anthem Blue Cross of CA, but after Anthem refused coverage for ADR, my surgeon's office recommended that I try a switch to Cigna, which then refused ADR coverage too.

    So I'm now thinking of paying cash for surgery abroad.

    But I was intrigued to learn that Anthem BC--I don't know what state affiliate--paid for ADR surgery at Stenum for some spine patients who posted here. It raised the question for me of whether Anthem BC of CA might pay for ADR surgery if done in Germany at Stenum, even though they refused coverage for ADR surgery here in the US.

    Does anyone have specific experience with Anthem BC of CA with regard to ADR surgery abroad?

    I ask because if I delay ADR surgery till after Jan 1, I could switch back to Anthem BC to see if they would cover surgery abroad, even though they refused coverage here. But I'd rather not postpone surgery as it's getting difficult to live with the pain symptoms.
    A herniated and serverely degenerated cervical disc C6-7 seems to cause all my symptoms. In the past year, the disc immediately below C6-7 also began showing up as some 90% degenerated. But it does not appear to be causing any symptoms as yet.

    My surgeon recommended replacing both discs with 2 Prodiscs. My insurance refused coverage.

    Should I do surgery? Pay cash for replacement? In Germany? Which surgeon and artificial disc? One level or two?

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    Moderator KBear's Avatar
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    Default re: Any specific information re Anthem BC of CA?

    I posted this somewhere else and can't remember to whom, so sorry if this is a repeat of something I have already said to you. Insurance depends on where you have the insurance from. Is it through a job? Do you work for the government and have government insurance? Or are you buying this policy as an individual (meaning not through work, like self employed)? Seems to me that people who work for the government have the best success rates with having surgery paid for. Second are people who have insurance through work. Your job actually has a say in if you get your surgery, not exactly sure how all this works, but have heard of several who went to HR and then got some or all of surgery paid for. The individual policies are the worst, I have yet to hear of someone having one of them and getting ADR paid for in full. I have an individual policy and was denied twice, they did end up paying a small portion, think around $10K; but would need to look at the exact number.
    31 years old-
    1/06- In wreck with 18 wheeler at 25 years old; 6/06- Head on collision on Interstate, both wrecks other drivers fault. Numerous MRI's, PT, chiropractic, acupuncture, TENS therapy, massage therapy, facet injections, epidural injections, Nerve study, Discogram, confirms pain in L4/5, IDET, decompression, Bi-lateral neurotomy L3/4/5, denied by insurance twice, in Active L clinical trial, had surgery March 17, 2009 in Miami, FL- received Active L disc at 29 years old. Pain and medication free as of October 2010!
    Mommy to Emma- 8 years, Ava- 5.5 years & had baby Eli after ADR, via c-section on March 25, 2011 , completely pain free still!

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