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Does anyone know of any insurance company that covers Cervical ADR?

AnonymousUserAAnonymousUser Posts: 49,900
edited 06/11/2012 - 8:26 AM in Back Surgery and Neck Surgery
Just signed up... I had a bad day.

I was scheduled for surgery this coming Thursday the 18th - Level-2 Cervical Disc Replacement - so I thought (waited four years to make this move). Took work off and have been crazy busy getting ready for Christmas etc. Well I learned today that I was approved for a 2-level fusion not ADR... and that insurance companies do not cover ADR's especially 2-level.

So with that said, I am disappointed to say the least. I don't know what to do? Any ideas/suggestions?

Thanks!

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Comments

  • YES! Aetna. I also am needing 2 level ADR(C5/6 and C6/7). I havent tried for approval yet but Ive been on top of researching this subject for over a year now. Aetna and United healthcare has approved some 2 levels, and I thik Cigna too. BUT, you have to fight for it with multiple appeals. They are counting on you giving up after their first denial. When they see you wont go away, is when you have the best chance at getting them to approve it. You need to know how to appeal it though. I have read that emotional pleading will get you know where with them. You need to counter their typical denial reason (experimental procedure)by proving to them that they (and many other insurance carriers) have already been approving 2 levels and show them studies (the disc manufacturer may help with this) of how ADR is cheaper and shorter recovery times, and as successful if not more succesful than ADR. These insurance underwriters/approvers often have no clue about ADR and are not familar with it, so you have to educate with good facts and logic in your appeal. A letter from your doctor explaining why ADR is better than fusion would help also. Google Laurie Todd's book "the insurance warrior". Its only about $10 and she outlays how to get insurance co's to approve you. I plan to start posting requests on this and the ADR board http://adrsupport.org/forums/showthread.php?t=9396 for people who have had 2 levels approved so i can get proof of their 2 level approvals also.I see ***EDITED*** this friday to confirm we are for sure heading that route.

    Doctors name and contact details removed by forum Moderator (paulgla). We do not permit publishing specific doctor's or institution names and contact details.
  • I thought my doctor told me that the FDA has not approved the use of ADR at more than 1 level?

    I have lumbar 2 level DDD, and have been offered the choice of either a 2 level fusion or 1 ADR + 1 fusion. But my insurance won't cover ADR at all, so if I decide that's what I want, I have to pay for it myself.
  • treefrog said:
    I thought my doctor told me that the FDA has not approved the use of ADR at more than 1 level?

    I have lumbar 2 level DDD, and have been offered the choice of either a 2 level fusion or 1 ADR + 1 fusion. But my insurance won't cover ADR at all, so if I decide that's what I want, I have to pay for it myself.
    Correct. FDA has not approved 2 level. But MANY people have had the insurance carrier still approve them. If you read enough on this board, you will find many people have had their insurance pay for 2 level ,some people have had Aetna pay for 3 level!! But its usually after fighting them with several appeals though, some after only 1 appeal and I once read someone who got it approved upon 1st try.

    I know cause Ive been perusing these back boards for years now. LOL. BUt most carriers will not approve it despite numerous appeals. Only the 3 I mentioned plus maybe a few I have failed to mention.So far, Aetna is the BEST of the BEST. They are VERY ADR FRIENDLY I hear.
  • I need two level at l4l5 l5s1. I am on disability but can get other coverage through my medicare such as an advantage plan etc. I need to decide between Cigna and Aetna. I've been told by the Dr's billing staff that these insurance companies will only cover this surgery if I am with a group or private insurance, not through an advantage plan. I need to have a final decision by the end of this year. Any advice would be appreciated.
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