List of Insurers Approving ADR Surgery

[Justin]

If your insurance paid for your ADR surgery, please post the name / state of your insurer in this thread.

Hopefully, this info will be helpful for those contemplating ADR surgery.

[melodyl]

My surgeon and I had to appeal my case twice before getting approval. I had 3 level (Prodisc C). Insurance agreed to pay for hospital, surgeon and one implant. We are still negotiating who is going to pay for 2 of the implants. Dr. Jens Chapman from University of Washington Medical Center was amazingly helpful. He wrote letters of appeal on my behalf and encouraged me to not give up. I came close to going to Germany and/or paying for the surgery myself here in the U.S. Either of those choices would have meant cashing in our retirement or refinancing our home. It took a lot of time and energy to get the insurance company to agree to pay for anything. I felt like I had a second job! I talked to and emailed my H.R. department, staff attorneys with the attorney general's office, and anyone else I thought might be able to help me. In the end it paid off, but there were many months that it seemed like my efforts were futile.

[Eastex]

At first my insurance considered ADR experimental. The Surgeon appealed and was told that UHC was going to approve ADR in about 6 months. I was tired of waiting and started seeing another surgeon for a fusion. (First Surgeon never offered fusion) I finally got a call that the ADR was approved. I have decided to stick with the fusion since it is L5/S1 and Facet concerns. So, UHC must be approving the ADR surgery now.

[Terry Allen Blackburn]

I have Blue Cross of Michigan. They paid the full amount for my four level ADR surgery done at Stenum Hospital on November 4th, 2006. The amount was close to $61,000. I sure was grateful. They have taken excellent care of me and my employees. I ensure almost 32 employees.

Terry Newton

[ans]

Wow, Terry. That is fantastic. I have BC and BCBS whom I hear in CA at least w/be the last holdouts - 'tho in '02 they were wiling to pay for a two level ADR that I chickened out of. Best to you. - Allan

[symara]

If anyone has any details they wouldn't mind sending me, please do... I'm new to the forum, but starting to build up all my research for my appeal when I need to submit it. I haven't had it submitted to insurance yet to have it denied, but I go to the Dr the 11th, so I'm sure it will be soon. I'm looking for any appeals that were won.

My e-mail is rblunk@insightbb.com

[jchebert1979]

I know this thread is older......Terry Allen, no disrespect but you were probably covered because you ensure your employees with BCBS. If they were to deny you they would risk losing your business.

[AmyBB]

After dealing with my insurance for almost a year, they have finally agreed to pay for my ADR.
I had the surgery in June '10. I agreed to pay out of pocket for it, but after the surgery filled my 4th appeal.
My insurance had made many mistakes along the way in the denial process and we made sure to highlight every.single.mistake.
We tore apart the medical policy. They told us that it had to go to an IRO. We made sure they sent everything. All medical records, all denials and our 44 page appeal we wrote.
IRO approved it!!! But that was not the final victory. Lifewise did not have to agree to abide by the decision.
Today I called, after they failed to return 3 other phone calls, and said yes, they would honor the decision and will start processing bills in the next few weeks.
Not only did we write a great appeal, but we kept record of the phone calls, all emails, all mistakes and anything else that would help us build a case. When our insurance company wouldn't do things properly we would quote Oregon state law in emails to them. I think they thought we had a lawyer.

Anyways, I live in Oregon. We have Lifewise, which is also known as Premera in other states. From all the research we found we are one of the first lumbar ADR's to be approved. We did find a Cervical that they had done a year or so ago.

[mmglobal]

Amy, what great news!!! Thanks for posting. I have felt that fighting the insurance companies was tilting at windmills, but the more recent successes will give many of us hope!!!

Thank you!!!! Great job.

Mark

[dshobbies]

2 thumbs up. Your perseverance pain off. Good for you!

[chasityrobles]

I have been discussing it with my insurance company for quite some time now. hope we resolve this sooner.