Blue Cross Payment 3-level Activ-L

[mmglobal]

I have a client who's spine was a complete train wreck. He went to Zeegers in earlier this year and had a 3-level Activ-L. I don't mean that he just needed a 3-level.. his spine was really messed up.

Because of the mailing for the Zeegers party tomorrow, we reconnected.

Originally Posted by Excerpts from his email:

Back doesn't hurt; posture better; walking better; ability to sit vastly improved; etc. Still some referred pain, would do better if exercised more. It has been a most eventful year, surgery; slower recovery than predicted.

Reminder: Federal employee with Blue Cross Medical Insurance. On inquiry prior to surgery, I was told that some of the costs in Germany might be covered; I should submit all medical costs; but most certainly, I would have to appeal. (Mark redacted actual dollar amounts, but he received well over 40K in reimbursement.)

So, I sent in the claim. I did not request reimbursement of expenses for GPC, airfare, hotel, etc., just medications and treatment. On the initial request, with no appeal. I still get goose bumps, I am so astounded! So, I am out about $8,000. This sort of good fortune has always eluded me.

He'll come and post more and has offered to share his well-prepared case if needed.

With any luck, he'll be at Zeegers' party tomorrow.

Mark

[Alaska]

Mark,

I'm very interested about the $8,000.00 amount. Are you saying that was his cost for the surgery? I am really looking forward to speaking with the patient who had surgery with Dr. Zeegers. See you tomorrow. Eric

P.S. It's still blowing , but only at 30 to 40 mph. It's about 22 degrees out so it has warmed up. It's supposed to blow 60 tomorrow so I am leaving just in time. I'm not looking forward to the turbulence tonight. It's supposed to be bumpy all the way to the west coast. My back will be a mess when I get to L.A.

[djscal]

Mark,

As you know Blue Shield intially paid for my Charite surgery in 2005 then rescinded payment 6 months later. I hired a lawyer and fought them and got them to change their minds and give the money back. So in the end, Blue Shield (Washington state) paid for my Charite in full.

I was out a few thousand in legal expenses, but it sure beat paying $50k (maybe more). My situation was very unique, as the case centered around the pre-certification (which they pre-certified). Blue Shield argued it wasn't done correctly and so had the right to reverse the claims and rescind payment. It was a long drawn out painful process, but I am glad that I prevailed.

Dan

[Poncho]

Mark,

I believe that insurance companies are beginning to "warm up" to the idea of sending patients abroad for procedures because they .... well lets face it....cost less. I will try to find the article. I think I know where it is at.

I will come back and post the link....

[Maria]

That I can get WCAB CA. to pay for surgery abroad. I'd happily pay airfare, Mark's costs and so forth just to get the surgery and stay covered which quoted for 3 levels is nearly half of what a hybrid (ADR and fusion) at 2 levels would cost where I've been here in CA.
My plan is submit cost estimate of everything and info re follow up doc (not secured yet) and hope that WC can see that they'd save a pretty good sum of $$ yet be sending me to one of the most experienced spine surgeons doing ADR. If not this, than probably one of most experienced spine surgeons here in U.S. which WC is working on currently~

[KL Aguilar]

Maria, I think we have met...maybe about four or five years ago, in a park in Huntington Beach. Cervie Queen, Mark, and others were there, too. We walked and had lunch.

I am also a WC patient and faced with a two-level ADR. Could you please share your WC journey with me? I am going to see an attorney today and would like to jumpstart the approval process. My e-mail address is AguilarKL@aol.com

[Kirk64]

Originally Posted by mmglobal

I have a client who's spine was a complete train wreck. He went to Zeegers in earlier this year and had a 3-level Activ-L. I don't mean that he just needed a 3-level.. his spine was really messed up.

Because of the mailing for the Zeegers party tomorrow, we reconnected.



He'll come and post more and has offered to share his well-prepared case if needed.

With any luck, he'll be at Zeegers' party tomorrow.

Mark

Mark,

Any chance you could put me in touch with this guy? I have BC/BS Federal Employee insurance, and am contemplating a 3-level ADR with Dr. B.

Thanks,
Kirk

[mmglobal]

Kirk, per your request, I just sent your email address to him. Hopefully, you'll hear soon. If not, let me know and I'll call him.

Mark