Happy Days!!!! Anthem BC/BS, Artificial Disc Replacement (In-Network Reimbursement, Stenum)

[treefrog]

Ben, what great news that your surgery was covered.

Do you mind telling me what state your BCBS is based in? I have BCBS of NC, and everything I have seen from their websites, is they don't cover ADR at all. I just submitted my claim, and I know that I am going to have to be prepared for an appeal.

[Terry Newton]

Cathy:

I wish you the best of luck in having your claim paid for. This is a prime reason we need health care reform.

Hang in there.

[Ben]

Cathy,

I live in Kentucky. Stenum made all the difference in getting the claim paid for I believe. We sent a letter of "medical necessity" before surgery and had a claim file opened before I got on the plane to Germany. I submitted my claim 30 days after I got home with a strong cover letter and got a check 30 days later. Don't quit.

[Terry Newton]

My four level ADR surgery also got paid for by going to Stenum Hospital. It was originally denied though they did pay it without me even having to file an appeal or anything. I also had BC/BS insurance of Michigan which is a non-profit Blue Cross. Stenum is considered an in-network provider.

Great news Ben. I hope you continue to make great progress in your healing.

[herniated C6-7]

Anthem Blue Cross/Blue Shield just reimbursed me 100% less my deductible for my 2 level ADR at Stenum in Germany!!!!! Stenum is a BCBS preferred provider so they even considered in-network! WOW!!! I am shocked and thrilled. The key words used are "medical necessity" when you approach your insurance company. Hope for everyone.

Ben

Which state affiliate of Anthem Blue Cross was that? Was it California?
Also, what artificial disc was used? Do you think Anthem might cover ADR with the M6 at Stenum?

[stogner245]

That is great news I had a 4 level done by bertagnoli, even with approval from the bluecross international people, bluecross of nc. is giving me no help in spite of perfect records. their reviewer who is a family practicioner said there was no evidence to lead to a review. you should see the records he has. would you be willing to provide me with some proof that they paid for this. It would help my case i think. I am going to have to get the insurance comissioner to review it all and blue cross is completely trying to keep from paying for and adr, not even one level. they just keep saying it is experimental. larry

[Justin]

That is great news I had a 4 level done by bertagnoli, even with approval from the bluecross international people, bluecross of nc. is giving me no help in spite of perfect records. their reviewer who is a family practicioner said there was no evidence to lead to a review. you should see the records he has. would you be willing to provide me with some proof that they paid for this. It would help my case i think. I am going to have to get the insurance comissioner to review it all and blue cross is completely trying to keep from paying for and adr, not even one level. they just keep saying it is experimental. larry

Stogner,

I think your reimbursement from Bluecross of North Carolina might be an uphill battle, as they just had a policy change effective January 1st, 2011 denying spinal fusions. It's amazing what they are trying to "get away with." See the thread here: Spine Patient Society Plays a Pivotal Role in Recent Uproar Regarding the New North Carolina BC/BS Policy on Spinal Fusion Coverage.

Good luck!

[lunaazul21]

Here's a dumb question:
How do we find out if the insurance does cover ADR out of the country?
Our insurance is blue cross blue shield from Houston Texas.
thanks,
Claudia

[Cindylou]

Here's a dumb question:
How do we find out if the insurance does cover ADR out of the country?
Our insurance is blue cross blue shield from Houston Texas.
thanks,
Claudia

You just need to either look in your healthcare manual or, call the number on the back of your health insurance card and just flat out ask them. They can look up your policy and tell you if it's covered or not. Good luck, Cindylou

[jss]

How do we find out if the insurance does cover ADR out of the country?

Claudia,

I ditto Cindylou. I have BCBS-TX and the manual states that there is no benefit for "Any services and supplies provided to a Participant incurred outside the United States if the Participant traveled to the location for the purposes of receiving medical services, supplies, or drugs.

However, if you will do all of the legwork and show them BEFORE surgery how much money they will save by covering a foreign procedure, you might have some luck in getting them to cover it.

Good luck, Jeff