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has anyone won an appeal for lumbar ADR when considered "investigational"?
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| iSpine Discuss has anyone won an appeal for lumbar ADR when considered "investigational"? in the Main forums forums; Hello. I'm a newbie to this forum. To make a long story short, I have a dessicated L5 - S1 ... |
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09-03-2013, 11:39 PM
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has anyone won an appeal for lumbar ADR when considered "investigational"?
Hello. I'm a newbie to this forum. To make a long story short, I have a dessicated L5 - S1 disk. My surgeon recommends ADR which I prefer over fusion; however, my insurance company BCBS of Louisiana has a policy against ADR stating that it is investigational. I decided to appeal. After a few weeks of research, I am a bit overwhelmed and could use some help. Has anyone ever won an appeal for lumbar artificial disk replacement when insurance labels it as "investigational"? If you have, would you be willing to share your appeal or pointers with me? I feel lost in the process of reading loads of articles; letters; opinions; studies; policies; court cases, and on and on. I would appreciate any assistance someone can offer. Thank you.
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09-05-2013, 06:35 PM
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LA Gal i am sorry i have no experience with ADR. I hope someone else on here does and comes forward to help you. I was never a candidate for it do to bad bone density.
However, most of all my 9 spine surgeries have first been denied by Aetna , the way they get turned around is when my surgeon does a peer to peer phone call with their doctor. I don't know if that has been tried in your case. Just want to wish you good luck. I have also battled Aetna for other issues and eventually won. Just takes a lot out of you sometimes Judy
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2007 ACDF 4-7 2008 hip , knee scope, hip replacement 2009 thoracic T-5 thru T-11fusion 2009 VATS T7-8, posterior only T11-12. removal of thoracic hard wear 2010 lung surgery 2010 T2-L2 kyphosis correction 2010 Kyphoplasty T-3, T-4 2011 Cervical osteotomy ,revision C4-T5 2011 Foot surgery 2011 Revision fusion T7 thru L4/laminectomy 2012 Hammertoe correction left foot 2012 Revision fusion T-12 thru L5 2012 Revision fusion L4-L5
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09-05-2013, 09:14 PM
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LA Gal, welcome to the forum.
Contact me off the forum and I'll send you some successful appeals. Unfortunately, BCBS is the worst of the worst at paying for ADR. Mark (You can reach me via the global patient network website linked below.)
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1997 MVA 2000 L4-5 Microdiscectomy/laminotomy 2001 L5-S1 Micro-d/lami 2002 L4-S1 Charite' ADR - SUCCESS! 2009 C3-C4, C5-C6-C7, T1-T2 ProDisc-C Nova Summer 2009, more bad thoracic discs! Life After Surgery Website President: Global Patient Network, Inc. Founder: www.iSpine.org
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