US/California insurance and ADR by Dr. Bertagnoli in Germany question

[Vlad]

Hi,

I just got a recommendation from Dr. Bertagnoli of two level ADR into c45 and c56.

Even though two level Mobi-C was approved by FDA last month, US surgeons need many years of experience to do multi-level ADR consistently right.

Can someone give me an idea how to deal with US/California insurance companies in order to make the surgery in Germany less financially unjustified?

I greatly appreciate any advises and help...

Cheers,
Vlad

[mmglobal]

There are spine surgeons in the US who have been doing multi-level cervical ADR for nearly a decade and have hundreds or thousands of ADR procedures under their belts.

I've not seen much success at getting the insurance companies to budge. Most of the successful cases I've seen are either with very wealthy patients who have Cadillac insurance policies, or people who work for self insured entities (like school districts) where decisions are made by a board made up of insurance company folks, plus representatives from the employer.

Good luck!

Mark

PS, if you get to the place where you are filing appeals, contact me (private message here or via the GPN website) and I'll send you some appeal docs that have been successful

[don_wagner]

Vlad,

All I know at this point is that only God or an executive order from the president can help you. They are probably equal in difficulty to obtain.

I believe reading somewhere that the equivalent surgery in India is less than $9000, but I had no assuances they were using the M6 or honestly sharing any details of the outcomes.

Don

[PepsiDoodles]

The biggest thing I have learned the past 2 weeks is that in the state of CA, Dr's that take your insurance, do not have to provide the same services as another Dr, they get to pick and choose in other words! Unlike most states, if your insurance is accepted, they all provide the same service,,not in CA! You need to shop around!!! For instance, last week I was told that 1 dentist in town took my insurance, and they would be more than happy to remove my tooth,,for me that was just not good enough so I called the insurance rep and got a list of every dentist in a 50 mile radius and called them all to see what they do and do not do,,and yes found a good one! I another city, but worth the effort, as there is NOTHING wrong with my tooth, just a small bone spur that needs removal at some point but can be put off for a long time, going to oral surgeon for evaluation,,,and he is ALSO covered as well as his procedures! So you have to "shop" in CA, it is a pain in the butt,,,,ya have to do it!!! Good luck!