Hello from NC (BC/BS Artificial Disc Replacement Denial)

[Marsee]

Just checking in, looking around for advice. I went to Dr. McAfee in Baltimore but his office was very discouraging from the start about getting BC/BS Federal to pay for the ADR. Every time I spoke to his office manager she encouraged me to have a fusion. After the first denial from BC/BS the doctor was not willing to do a peer-to-peer review. Moved on to TBI and Dr. Zigler but that has been a slow process and discouraging as well. I can't seem to get calls or emails returned for a few days. Anyone have any tips? Is this just par for the course with surgeons? I don't know what to expect. Sorry to start out so negative; I'm in pain and exhausted

[Hooch]

Hi, sorry to hear you are struggling.

It can be a slow process getting response from surgeons. If you have the appropriate scans and funds now is a good time to spread your net wide and get a few opinions.

Welcome.

[Justin]

Hi Marsee,

Welcome to the Spine Patient Society.

I'm sorry that you are having difficulty with appointments and insurance approval for artificial disc replacement. In terms of suggestions, be persistent. In the past, I found calling is the best way to get things done. Also, if someone is particularly helpful in the office, take their name down and ask to speak to them when you call.

Good luck and please keep us posted.

[Cindylou]

Welcome Marsee, Welcome to SPS. It can definitely be a challenge to get the ball moving for you, but like others have said, be persistent. You just have to be. Nobody is going to take as big of a vested interest in you or your situation but YOU. So just don't give up. Dealing with all the red tape is not for the faint of heart, that's for sure. I like Justin's idea too, of writing down the name of someone in an office, if they were especially helpful. Any trick you can find to get someone to care and listen, and get a door open. And then stay on it for moving forward. I remember years ago, when I was so new to the whole system of pain management, and just everything, it was all so overwhelming. It took me a long time to even make that first phone call in my cry for help. And then this particular office never even returned my phone call. It just killed me with defeat. Took me a long time to muster up the courage to start over and make that next phone call. Don't be as timid as I was. Keep at it. I wish you only the best, Cindylou

[Marsee]

Thanks for the encouraging words, everyone. My husband has been wonderful, spending countless hours being a "squeaky wheel," calling people at TBI. Finally we got some kind of explanation of what has been going on an apology for the long delay. My paperwork has been submitted to BC/BS and we are now waiting.... There is some question about whether they will deny the claim because I have not been seen at TBI; apparently, this has been a problem lately with a couple of insurers. We decided to take our chances and see if it gets kicked back. In that case, I guess I will fly down for a consult/exam and resubmit.