Welcome, Friend!

It looks like you're new here. If you want to get involved, click one of these buttons!

advertisement
advertisement
Veritas-Health LLC has recently released patient forums to our Arthritis-Health web site.

Please visit http://www.arthritis-health.com/forum

There are several patient story videos on Spine-Health that talk about Arthritis. Search on Patient stories
Protect anonymity
We strongly suggest that members do not include their email addresses. Once that is published , your email address is available to anyone on the internet , including hackers.

Notice
All discussions and comments that contain an external URL will be automatically moved to the spam queue. No external URL pointing to a medical web site is permitted. Forum rules also indicate that you need prior moderator approval. If you are going to post an external URL, contact one of the moderators to get their approval.
Attention New Members
Your initial discussion or comment automatically is sent to a moderator's approval queue before it can be published.
There are no medical professionals on this forum side of the site. Therefore, no one is capable or permitted to provide any type of medical advice.
This includes any analysis, interpretation, or advice based on any diagnostic test

Insurance Precedent

pamelabppamelab Posts: 1
edited 01/30/2013 - 7:37 AM in Back Surgery and Neck Surgery
I am new to the forum. I have cervical DDD levels c4/5 through c7/t1. I had a multi-level ADR by Dr. EDIT in September 2011 and have been thrilled with the results. Initially my insurance company paid the claim but is now rescinding that and demanding I return all monies paid, as the multi-level ADR is deemed experimental. I am looking for any cases where insurance has paid for a multi-level cervical ADR, whether in the United States or abroad. I read somewhere that BSBC has paid for military but I cannot find that information anywhere. I appreciate your help.


Post edited. Forum rules prohibit the naming of specific doctors.
advertisement

Comments

  • kamgramkkamgram Posts: 483
    edited 01/30/2013 - 6:44 PM
    You surgeons office should have gotten the surgery approved before they did the surgery then there would have been no reason to want payback. Prehaps your doctors office worded it different and this was approved by insurance but then when they seen surgery notes they realized this is not what they were told. Perhaps your surgeon got in there and decided he needed to chnage procedure. I would check with insurance and see what the problem is and then call surgeon's billing office and have a talk with them. I know working in doctors office and having BCBS at one time they have done this to me but not for major back surgery. Good luck and let us know how it turns out.

    kelli
  • I don't think they have a chance on getting you to reimburse them for a surgery they approved.
    They might against the doctors insurance.

    Don't loose any sleep over it.

    Dave
    -Dave
    L4/5 herniation13mm sequestered fragment L5 root compromise.
    L3/4 annular tear.
    L2/3 3mm bulge and annular tear.
    Tens mpo combo system
    Epidural L4 L5 28Nov12 / 12Dec12 / 26Dec12. All no relief :( SO FAR
    MicroD L4 L5 May 23 2013
  • jlrfryejjlrfrye ohioPosts: 1,110
    A approval is not a guarantee of payment. I bill insurance for a living for Drs.. and I have seen this happen more then once. Somewhere is your contract this particular surgery is listed as experimental. Contact your surgeons office and see if they can use a different procedure code to send a corrected claim to avoid the surgery being unpaid. As for the Drs payment they will do a take back on the claim and use the money to pay another claim, so it doesnt matter if your Dr. agrees to this or not the money will come out of a future check owed to him. Trust me your Drs. office will everything they can to get this paid and if they dont PM and I will help you thru the appeal process
    Susan
    Susan
Sign In or Register to comment.