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Denial of coverage for 2 level ADR

AnonymousUserAAnonymousUser Posts: 49,622
edited 06/11/2012 - 7:35 AM in Health Insurance Issues
After being recommended for 2 level ADR - C5-C6, and C6-C7, was informed after multiple appeals that a 2 level ADR is experimental and not covered by AETNA insurance. Now one year passed and pain has increased significantly in arm and hand. Has anyone had similar experience with AETNA and was 2 level ADR approved? My only alternative now is to have a single level and hope that majority of pain in left side is minimized. Any comments on this appreciated as pretty frustrated.

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Comments

  • Please have your surgeon appeal to the insurance company for further review. He may need to do what is called 'peer to peer' review. Where your surgeon talks to a Dr at the insurance co. Dont take the insurances word that this is not a covered benefit... >:D<
  • You may try to get ahold of the manufacture's rep in you area for the ADR surgeon is going to use. The surgeons office should have the number. You can also google it and find them as well. The maybe able to provide the data along with the surgeon's request to the insurance company. The rep does have a interest in getting two level ADR approved as the more that is done the more will be approved and he/she makes more money on the sale of them. Good luck keep us posted.
  • :? Much appreciated. Doc has had a peer to peer review after first appeal, no luck. No luck with rep either. Now my left arm and hand are numb and am tired of sleeping with my arm over my head.
    Go in for pre-op meeting this Tuesday to move forward and do single level ADR. Thanks again!
  • :? Much appreciated. Doc has had a peer to peer review after first appeal, no luck. No luck with rep either. Now my left arm and hand are numb and am tired of sleeping with my arm over my head.
    Go in for pre-op meeting this Tuesday to move forward and do single level ADR. Thanks again!
  • Could you update us as soon as possible. I am somewhat behind on the pain thing but my tingling and numbness are starting to terrify me....

    Thanks!
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