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Reply With QuoteWelcome Joanne and sorry you are dealing with back problems. Here is a link to a thread about whether insurance paid for ADR or not. Was your surgery paid for by insurance? Or not?
This is a discussion on New member with cervical stenosis on 2 levels (Denied by Anthem BC of CA for the Prodisc-C Implant) within the Health Insurance forums, part of the Insurance and Travel Forums category; My name is Joanne. I have been dealing with Cervical Stenosis on C 5-6, C 6-7 for over 3 years. ...
New member with cervical stenosis on 2 levels (Denied by Anthem BC of CA for the Prodisc-C Implant) My name is Joanne. I have been dealing with Cervical Stenosis on C 5-6, C 6-7 for over 3 years. The problem is progressing. I have been denied coverage from Anthem BC of CA for the Prodisc-c implant. I am in the process of filing my appeal. I know many of you have been in this situation with insurance. Has anyone won an appeal with their insurance company? Any help would be greatly appreciated. Thanks!
re: New member with cervical stenosis on 2 levels (Denied by Anthem BC of CA for the Prodisc-C Implant) Welcome Joanne and sorry you are dealing with back problems. Here is a link to a thread about whether insurance paid for ADR or not. Was your surgery paid for by insurance? Or not?
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- 6 years & had baby Eli after ADR, via c-section on March 25, 2011, completely pain free still!
re: New member with cervical stenosis on 2 levels (Denied by Anthem BC of CA for the Prodisc-C Implant) Welcome Joanne. I am also sorry you are dealing with neck pain and stenosis. You have come to a great community of folks who get pain and are also very supportive and knowledgeable. Alot of us have been denied coverage of our ADR's after numerous appeals. That said, cervical ADR's seem to hold a better track record of coverage. Hopefully, those who got some coverage will respond soon. Meanwhile, are you familiar with Laurie Todd, who wrote The Insurance Warrior? A highly recommended book. :thumpup:
• January 2000 MVA passenger, used jaws of life to retrieve me, neck injury and months of PT
• June 2001 Bicycle accident, 2 compression fractures at T12/L1, Vertebroplasty Sept. 2001
• April 2006 right hip, labral tear and repair
• April 2007 3 level ProDisc @ L3/4, L4/5 & L5/6✷ ✷Lumbosacral transitional vertebra; Dr. Rudolph Bertagnoli
• July 2, 2008 ALIF & Laminectomy @ L6/S1
• July 30, 2008 re-opened 28 days later to remove bone cement that had leaked onto S1 nerve root
• August 2008 Pulmonary embolism, double pneumonia, collapsed left lung, re-hospitalized 1 week
• March 10, 2009 Right SI Joint Fusion
• April 27, 2010 2nd right hip arthroscopy to remove adhesions and release psoas muscle
• September 30, 2010 lumbar facet rhizotomy
• December 9, 2010 12 bilateral lumbar trigger point and steroid injections
• December 23, 2010 12 more bilateral trigger point injections w/o steroid
• February 15, 2011 ESI bilaterally in lower lumbar...relief only for few days. Considering 1 more.
Did Spinal Cord Stimulator trial from 5/11/11-5/17/11 with excellent results; Spinal Cord Stimulator surgery is Monday,
July 18, 2011
re: New member with cervical stenosis on 2 levels (Denied by Anthem BC of CA for the Prodisc-C Implant) Joanne,
I have BCBS-TX. They approved my pre-determination in 2008. I had surgery in late 2009 at which time they denied the claim saying that it was not "Medically Necessary". I read Laurie Todd's book and then appealed. Based on my appeal BCBS-TX backed off their claim that it was not medically necessary, but then denied again claiming that it was "Investigational and Experimental". I am currently working on that appeal.
I do highly recommend Laurie Todd's book.
Good luck, Jeff
C4/5 fusion, January 2000
C5/6 fusion, February 2002
C3/4 & C6/7 - M6 ADR, Nov 2009, Barcelona
Conceded defeat to a manifestly disingenuous BCBS-TX in my quest for reimbursement, Jan 2011
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