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Are there any ins. lists circulating concerning ADR coverage?

jenfabjjenfab Posts: 56
edited 06/11/2012 - 8:38 AM in Health Insurance Issues
I want to know if my ins is on the "most likely will cover list".

I need a double level ADR at L4-5 L5-S1 and am concerned..SO concerned about my ins. covering it. Any info would help.


  • My dr and I discussed the ADR today. He says in TN, no ins will cover the ADR. But he said while doing his fellowship at Johns Hopkins, they did them frequently. So it may be geographically based and I am sure JH does a lot of trials. He also said the process for choosing patients is really important. He did not explain further and I did not continue to ask since I'm not having that.

    Have you checked with your ins or had your surgeons office check on certification or authorization with your insurance. That might be a good route to try.

    Best of luck.
  • I was given a booklet from my surgeon regarding the ADR and it had a section in it regarding the insurance process and the appeals process. I beleive it gave me a website that showed which insurance companies do/do not cover this surgery. You may want to try to google it and see if you can find it. If I come acrossed it in my paperwork I will send you the link.
  • That would be very helpful thank you. I dont see my surgeon until Dec 15th..but of course will ask then. I am partly VERY afraid to know the answer.
  • I am having 3 ADR's in Straubing, Germany on Feb 2nd. I am going to try an appeal through Premera. I am 34 and my NS here in WA didn't want to do 3 level fusion. I'm paint $64,000. For the 3 level. I think Dr. Edited does a pretty cheap 2 level and he has done 4,000 of these. Pick a surgeon with lots of ADR experience. I don't have the $ to do this but I sold my car, 4-wheeler, motocycles,etc. I hope we can appeal our cases. If you go through Premera I know who to start the case with get a letter of medical necessity because of your age. Also work with your states insurance commissioner. Good luck

    Post edited by Authority Member haglandc to remove name of medical professional
  • Hey Kendrak,

    I just got my estimate back from Dr. B and its the same price, I also need a three level ADr L3 to S1. I am holding off for now due to my local surgeon wanting to take more tests to get to the bottom of my pain issue to see if he can help me with it.

    We are still keeping germany in mind for surgery and may be going over there next fall. Keep us posted on how everything goes.........GOOD luck with it all and here is to feeling great here in a few months!

  • I was told by my doctor the only insurance carrier that will cover a ADR is Aetna, thats in Georgia, not sure in other states. I wanted to see if I could get the ADR done, my doctor said, he has seen problems with ADRs but my only choice if I wanted to get one would be to go out of the country. :(
  • Eric,

    Several insurances are covering it now. I just had the ADR in January and my insurance covered it. Its a small insurance and not many people have it but its called IAC, a multiplan insurance. Also, I would think that it would be harder to appeal and have the insurance pay an out of country doctor vs. one in the states. Just a thought........

  • SpineAZSpineAZ WiscPosts: 1,084
    Is it that you would seek to buy new coverage that would cover ADR? Any individual plan will not cover any pre-existing conditions. So if you have insurance through your employer you may only have 1-2 choices of potential insruance companies. My employer reverted to one insruance company only last year and my husband's new job is the same way. No options, one plan under one insurance company.
    2 ACDFs, 2 PCDF, 3 LIFs; Rt TKR; Rt thumb fusion ; Lt thumb arthroplasty; Ehlers Danlos 
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