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bone stimulator - insurance will not pay

lisadaylenellisadaylene Posts: 79
edited 06/11/2012 - 8:48 AM in Recovering from Surgery
It has now been two months since my fusion surgery, and NOW my insurance has denied covering the bone stimulator I have been wearing since it was brought to me a few days after surgery. Insurance letter states that it is "experimental" and they do not cover such things.
I am perplexed, I have read that the rate of fusion is doubled in studies, and many people have had great success with them, so I had no idea when I started wearing it that it was still considered experimental. Has anyone else dealt with this? I am thinking about filing an appeal. Or at least sending it back in the box it came in with all manuals, and saying I never used it! The insurance was charged $5,000 for it, and I am certainly not paying for it.
Thank you for any help.


  • my insurance has a disclaimer that says even though they approve a procedure they might not pay the actual bill!I would certainly appeal. If you are pleasant, calm and persistent, and knowledgeable they will see things your way. good luck
  • Actually, this happened to me with the home traction unit I had before my ACDF surgery when we were trying conservative measures.

    I called the company that made it because it actually came with a return bag and they said I could return it at any time. So when I knew I was having surgery, I returned it. That's when the battle started. The company that issued it to me (Co. A) kept arguing with me about returning it, but the company that I returned it to (Co. B) had no problem.

    The guy at Co. A kept calling and saying that I needed to pay for it whether it was returned or not. I eventually told him to call Co. B, it was between them. When he argued with me I told him that I no longer had the unit and his job was to deal with Co. B to get this straightened out, not me, that I wasn't going to do his job for him. This was after I was sent three invoices for the unit. I never heard from him or Co. A again.

    So be the squeeky wheel. See if there's a return bag with the unit and use it to send it back and deal with the other guy later. Or call the manufacturer and see if you can get their approval to return it, if that's not who you're talking to. Once you've returned it and they've accepted the delivery, you can't be billed for it.

    On a side note, I'm sure they knew I used my traction unit because I had to use it on the floor and with the kind of material it was, the dog hair stuck to it like glue. I cleaned it up best I could, but it was obvious that there was dog hair on it. LOL

    You can even keep using it while you battle this out and get to the point of sending it back. Good luck. Let us know how it goes.

  • Wow, lots of people get bone stimulators. Experimental?
  • Chris, I always start with calm and pleasant and then something else takes over. lol
    and HappyHBmom, I know, thats what I thought!

    Cathie, thank you for telling me your story with your traction unit. I kept the original box and since my stimulator is just worn around my waist while I sit or walk around, you cannot tell that it was used at all. I do think that my unit had been used before and here is why: when the girl came to my house she said that I was to use it two hours a day, BUT, it was set for 4 hours and she could not re-set it. So I had to stop wearing it at 2 hours. Really? The original manual says it can be set for whatever you need. That makes me wonder if someone else had it and returned it like I want to and they then gave it to me hoping that my ins. will pay.
    The unit is made for one person only and then is supposed to be thrown away I guess. Unbelievable. I will let you know what happens.
  • Lisa,

    About 2 weeks after getting my bone growth stimulator I got a letter from my insurance (BCBS Fed) that basically stated that "they" didn't understand what this device was, and why I needed it, and therefore they are debating whether to pay for it. I called them and explained what it was, and what it was suppose to do, and problem solved - they paid.

    Have you spoken with your prescribing physician of this? It could be he could write a letter that you can submit to your insurance company to get this cleared up? Fingers crossed this gets resolved for you. *HUG*

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Thank you Brenda. I have not gotten a bill yet for this, only the insurance statement saying that they denied it. If and when I do get billed for this, I will definately take your advice and have my doctor either call or write a letter letting them know what it is and why he prescribed it. Or, maybe I won't wait, I will call my doctor and talk to his office to see what can be done. Thank you for your help.
    hugs right back at ya.
  • Lisa,

    Since you already got notification from your insurance that they don't intend to pay for it, I would get that information to your doctor ASAP. Once a bill is issued, it can create a whole new mess of paperwork to clean up. You might also be able to get with the rep for your stimulator, as they might have a brochure you can add to the paperwork for the insurance. Pretend in your mind that you are replying (to the insurance) to someone that has NO clue what the device is. Fingers crossed for ya!!

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Thank you Brenda, I will do that. I appreciate your advice. I guess hoping it will just go away and I never hear another word about is about as likely to happen as me go skydiving tommorow. LOL
    I am going to call my doctor's office and let them know whats happening.
  • You're Welcome Lisa. Question? On the statement where they stated they would not pay for the stimulator, is there a contact number for questions? As I said for mine, all it took was a phone call. The lady I spoke with (BCBS) told me the reason they were originally going to "not pay" was there was no stimulator surgery! See, they thought all bone stimulator's were like the pain (SCS) stimulator's. Once they realized this was external, all was well. It could be as simple as "their" misunderstanding what the unit is.

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Yeah Brenda, I have heard of those internal bone growth stimulators. Tomorrow I will look for a number and call them to let them know it is something I wear. It is still amazing that they charge $5,000 for them. Thank you, and I will let you know what happens.

  • Lisa,

    If they "still don't get it," then you can go to Plan "A" as getting with your doctor or the Bone Growth Stimulator rep to get a letter and brochure and go from there. Also, if you do have to get with your doctor's office, make sure *they* know your insurance is giving you this problem. Mine is from Orthofix, and I think my co-pay was around $75 - $125 <--- I don't recall the exact co-pay at this point. Good luck!!! :)

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • yes, mine is Orthofix too, and your copay sounds a whole lot better than five grand! I will keep you posted, thanks again
  • Reading this, How is it that a orthofix rep. can deliver this to your home, before they had some sort of guarantee of payment from someone.
    If ins. co. still refuses to pay for it, return it back to orthofix and it's their problem.
    Sounds like orthofix jumped the gun a little.
    Also the bone growth stim. is not experimental, it already has a proven results.
  • Yeah Jim, I wondered that also. The doctor, hospital, physical therapist, no-one does anything unless they know it is paid for it. I have the box and manual, and I will for sure send it back if no-one is paying for it.
    I went to my doctor's office, and yesterday since the billing dept. woman was out, I have to go back on Monday to physically hand the insurance statement to her, the receptionist would not take said she did not want to be responsible for it! Really? What a way to run an office.
  • Lisa, Jim,

    They delivered mine the same morning my surgeon ordered it. So "who pays" was not on the reps main thoughts. She told me that my insurance would most likely *not* turn it down. I did get a letter as I said from my insurance company as they were debating as to whether I medically *needed* it. One phone call, all was cleared. I'm guessing that is what may now happen with you Lisa? Fingers crossed.

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • They delivered the stimulator a day or so after I was released from the hospital and like I told my husband, hopefully while in a drugged up state, I did not sign anything stating, I would pay if ins. didn't. I am sure I did not, but until this is over, I will continue to worry.
  • Sounds like a confusing mess.
    I did'nt even know i was getting one until the rep. called me 3 days after surgery, and said he was bringing it over to the house.
    I asked him who ordered it and he said your surgeon, then asked if work comp. approved it and he said "yup", already approved.
    So Lisa my best quess would be ask your surgeon's office who they contacted, to get approval for this, and find out who screwed up.
    I still think orthofix jumped the gun on this.
    Good luck to ya.
  • My surgeon didn't put me on mine until I was around 4 months out! And too, that because so many of my symptoms were still there. It unfortunately didn't help me in the end (I think it was too far along in the process for me) my other osteophytes have increased in size. I've never gotten an answer as to whether the stimulator affected my spurs. At that time, *all* their trials were on people with the fusion issue only, and no other issues at other levels.

    The other good part, if they have to go back in and revise my neck, I already have the stimulator! (G)

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Hoping for the best for you.
    If you do need another surgery, check on the life span of your bone stimulator.
    From what i understand there is a pre-programed life span on them, i'm assuming so we cant turn around and sell them after we are done with them.
    Which would make sence to me, from the companies standpoint.
  • Jim,

    When the rep came to my house I asked her about that. She said all I had to do is call her, and she will reset the device. :) If I do get revision surgery, I will use it right out of surgery this go around! I call it my "Darth Vader Chest Plate!" (G)

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • I forgot to ask. What did your surgeon or his staff tell you about the stimulator and payment? I have a feeling this will all shake out well, but was just curious. Thinking of you.... :)

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Lol, yea these things look great dont they.
    Definitely a fashion statement.
    I dont leave the house with mine on except to take the garbage out.

    Oh and i did'nt know they could reset them.
    Forgot what we were talking about
  • Umm... Lisa's possible issue with her insurance paying for her stimulator? (G) I was thinking about her predicament, and I just can't see her being turned down if the doctor gives them the information as to why she needs "this prescription"...of course that is just my logical thoughts there Lisa!!

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • I am going to the doctor's office again today, to see the "billing" department. I still think that mine was used. When the rep brought it, she said it is set on 4 hours, and that I was to use it for 2 hours a day, so every time I use it I have to watch for it to say 2 hours left and then shut it off. I am thinking that the previous user used it for 4 hours and that she did not know how to re-set? Just another reason that I do not want to pay for it. I will let you know later if anything happens.
  • Lisa,

    OMG! Used? Eww...that ranks up there with sharing hats, brushes - eww! Why do you think it's used? I would have a bird! I hope you get answers today. And if they did give you a used one, I would let my doctor know for sure. Good luck when you get there!! *HUG*

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Good luck, and also if you are suspecting that it is a used device, there is a way to find out for sure.
    There is some kind of computer in it where they can see if these things are being used, i would guess thats for ins. co. purposes.
    Read in your owner manual and it says that they can tell the usage, i guessing by plugging it in to some kind of computer and that will say when it was being used.
    But i'm sure that info. could also be erased just as easily.
    Also mention you just got out of hospital, and obviciously, on strong meds at the time, and had no idea they would be foolish enough to bring that over to you unless they already had a authorization for payment from your ins. co.
    Did the rep. leave you his/her phone# when they delivered it, if so call them.

  • I had been wondering if a bone growth stimulator could possibly cause unwanted bone spurs to grow.
    Then I read your comment.

    Did you ever get an answer from anyone as to whether this was likely?
  • Howdy Jellyhall,

    No, no one replied to me from the company. Big surprise huh? I can say this. When I compared my prior x-rays (a year apart) the spurs were about the same size. When I compared the last set with the 6 month x-rays - they were bigger and more prominent in only a few months.

    Of course a 'good lawyer' would come out with "But, do you have medical proof that nothing new changed in your neck that *also* could have caused them to grow!" Grrr.. Of course, he would be right, but I do believe that the stimulator allowed them to grow faster. :)

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Ok, I met with the woman in charge of billing. She said that she would give the ins. paperwork to the other woman who deals with Orthofix. She could not imagine it being used, but I am going to find out Jim if we can indeed find out if it was used.
    I do not have any name or number of the rep. that brought it to my house.
    The woman in billing did however say that this afternoon they would be on the phone with Orthofix and the insurance company. So I am just going to wait and hopefully get no new bills.
    Now if I can get out of jury duty tomorrow. Think they want someone on a jury who is on percocet? LOL
  • LOL that'll be funny to see.
    Do you have a back brace? Wear that to jury duty also and show them your meds. I would think that will be enough for them to let you go home.
    Strange the rep. did'nt leave their phone#, in case you had problems with that thing. They gave me their #, and told me to call if any problems.
    Just dont let up on them, and let them know clearly you would never have accepted it if you knew you would have been stuck with the bill.
    Personally i think it's a load of cr@p that the ins. co. is denying payment of it for you. And orthofix possibly giving you a used one.
    If they by chance gave you the manual, if not look at their website it's also on there, that these things can be checked for usage. orthofix.com

    Good luck Lisa.
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