Insurance Companies APPROVING Artificial Disc Replacement (ADR) Surgery

[Justin]

I know Terry was successful having Blue Cross of Michigan cover his 4-level (2-level cervical, 2-level lumbar) surgery.

Anyone else successful with coverage for ADR surgery?

[RedStang]

My company is self-insured with Allied Benefit as the manager and Aetna providing baloon coverage. I had to fight for it but with my companies assistance got the surgery approved. ActiveHealth Management is the company that oversaw the precert procedure and was terrible to deal with. FWIW they are a subsidiary of Aetna. Supposedly my case prompted Aetna to review ActiveHealth's policies.

Jason

[Justin]

See the Blue Cross Blue Shield of Texas Cervical ADR Approval Letter thread in this forum.

[Cindylou]

My husband's company is self-insured and use a 3rd party administrator. I had to go through 3 appeals, and even tho the final one was a "no," at the end of the day the president of the company graciously ended up paying for half of the bills, out of compassion. He also had the company pay for my roundtrip first class tickets to Germany and back, which I was eternally grateful for. :thumpup:

[Justin]

If anyone has an approval letter regarding artificial disc replacement, please send me a PM or an email.

Of course, ALL identifying information would be removed and all letters would require prior approval before sharing with the community.

Thanks for reaching out to help other SPS members!

[Jeff]

This link I found last night as of spring 2009, shows a list of insurance companies that cover the proceedure.

National Insurance Carriers Now Cover Artificial Cervical Disc Surgery : CINN News & Events

[trkdoc714]

I stumbled onto this link listing insurers that have covered ADR in the US. I've asked permission from RMSAS for permission to post the lists. Until they allow it, the link will have to do.

Lumbar and Cervical Spine artificial disc replacement

The lists are PDFs at the bottom of the page.

I have no ties to RMSAS other than they assisted me finding a local surgeon to do my follow ups after surgery. I was refered to them for that purpose by my roomate at Stenum.

I hope those searching find their insurance company on the lists.

Bob

[lolenona]

I had my 1-level Cervical ADR surgery paid for by BCBS of ND. I only had to pay my deductible and co-insurance. The rest was paid for by my insurance company. My insurance company based their decision on the following criteria:

1. a medical necessity after conservative treatment failed,
2. compression of the spinal cord
3. symptomatic nerve damage.

Hope this helps.

[lgabrysch]

My husband is in need of ADR C5-6. We received our denial from BCBS of CA this week. We are now preparing an appeal. I was reading on lolenona's post that you were approved by BCBS of of ND. Was this after appeal or were you approved right away? That is great!! My husband is a healthy 44 year old with a ruptured C5-6 causing nerve and spinal cord compression. He also has a bone spur which has broken off and is in the spinal column. Sounds very much like your case. Just wanting to get all the info I can before we appeal!! Thanks for any help or info you can give!!