ADR & Foreign Service Benefit Plan

[jessmith07]

Hi everybody,

I'm looking for anyone in the Department of State or the Foreign Service and has Foreign Service Benefit Plan insurance (a/k/a Coventry/First Health) that was successful in getting the insurance company to pay for ADR surgery. When I first submitted for precertification, they denied it stating that the procedure wasn't FDA approved. When I provided them with the FDA approval letter, they then denied it again, claiming "there was insufficient evidence in the literature as to the efficacy of the artificial disc" and they were denying it as it is not "standard of care."

I am now trying a different route. Under HIPPA, if this insurance company has approved this surgery for anyone else under the same plan that I have, then they can't deny it to me. All I need is one person, then I can go to the Department of Insurance in my state (South Carolina) and file a grievance.

Please feel free to send me a message.



UPDATE: As I was gearing up for battle by gathering up all as much info as I could, the insurance company finally approved my surgery! I am going to find the proper forum to post all of the information that I submitted to successfully appeal an insurance denial for an ADR procedure. If we all fight and begin to win, we can make ADR the standard of care, and people will no longer have to suffer through fusions...


Thanks,
Jess