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  • Fight with Insurance or do ACDF

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    Old 03-09-2009, 06:44 AM   #1
    rehmlh
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    Fight with Insurance or do ACDF

    2 weeks ago, my doctor decided that I needed surgery. C6-7 needs to be fixed. I meet all the criteria for ADR but Cigna is denying it. They changed their policy in December 08 from paying on a case by case basis to deny all. My Doctor has filled an appeal but I do not know how much longer I can hold out for the appeal. I have constant headaches, numbness in the left arm and face, and shooting pain down the right arm. My doctor is fairly confident that if I have ACDF, I will be back within a few years to go up 1 level but does not want to fuse it now as it is not causing symptoms.
    Has anybody had any success fighting Cigna in 09?
    Should I just go forward with the ACDF?

    Last edited by rehmlh; 03-09-2009 at 06:48 AM.

     
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    Old 03-09-2009, 06:53 AM   #2
    want a good out
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    Re: Fight with Insurance or do ACDF

    Fighting the ins. comp. is more of "who can hold out longer". If you can't deal with the pain, you have a decision to make. If you wait you may end up with perm nerve damage. It is a gamble if the levels above and below will hold up. Would you consider getting a personal loan to cover it? I thought about waiting for the multi level one and decided to have it fused. I couldn't deal with the pain any longer. It changes you. 4 years ago, I decided to hold off and like I said, I just had 3 levels fused. 4 years ago it would have been just one. I have a physcal job, (Nurse) and the demands of the job helped degenerate the other discs. I have yet to talk to my Dr. about long term restrictions. I say the choice is yours. If you do need more surgery, hopefully you will still have cigna to pay for it... Good luck with what ever you decide on doing.
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    Old 03-09-2009, 08:51 PM   #3
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    Re: Fight with Insurance or do ACDF

    Have they provided you a written denial with explanation? You should ask for that so you can see why they are denying the claim and then have your physician's office advocate on your behalf.
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    Rt thumb fusion '13. R&L thumb arthroplasty '12 ; RT TKR & Bilat CTS' 11. Fusions: L5-S1('87), L4-S1('93), C5-C7('06), L3-S1('10), C4-C5('13). C5-C7 foraminotomy '08

     
    Old 03-10-2009, 06:50 AM   #4
    rehmlh
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    Re: Fight with Insurance or do ACDF

    Quote:
    Originally Posted by SpineAZ View Post
    Have they provided you a written denial with explanation? You should ask for that so you can see why they are denying the claim and then have your physician's office advocate on your behalf.
    Denial states that there are no long term broad based studies to show the replacement are better. My doctor has already filed an appeal with the help of the ADR manufacturer. My problem is waiting more than the 2 to 3 weeks for this appeal. I am a teacher and I am finding it harder and harder to get to work every day. School has been great about me missing here and there, but I do not know how much longer I can hold out.
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    ACDF C6-7 3/31/2009. Disc herniations and cord impingement at C5-6.

     
    Old 03-10-2009, 08:51 PM   #5
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    Re: Fight with Insurance or do ACDF

    Ahh, sorry to say that it will be hard to get the denial overturned. In general insurance companies see ADR as too new and not yet determined good in the long term. And your insurance company tends to favor the more conservative treatment options that are considered "tried and true" like ACDF.
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    Rt thumb fusion '13. R&L thumb arthroplasty '12 ; RT TKR & Bilat CTS' 11. Fusions: L5-S1('87), L4-S1('93), C5-C7('06), L3-S1('10), C4-C5('13). C5-C7 foraminotomy '08

     
    Old 03-11-2009, 06:52 AM   #6
    rehmlh
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    Re: Fight with Insurance or do ACDF

    Doctor has phone appeal today or tomorrow. We have already started the 2nd round appeal letter and have all the research articles ready to go in case the phone appeal does not work. The company that makes the disc say they are seeing 10% to 15% successful phone appeals in patients with issues simalar to mine and around 40% success with the 2nd level appeal. They have had recent success with my insurance so at least I have a chance.
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    ACDF C6-7 3/31/2009. Disc herniations and cord impingement at C5-6.

     
    Old 02-22-2010, 02:06 PM   #7
    seabiscuit99
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    Re: Fight with Insurance or do ACDF

    I was pre-approved by cigna on phone with a code number to go with it. Had my foot surgery and then the idiots would not pay the bills. Went thru all the appeals with them to no avail. Guess i will be suing them and the company where i work. Always have trouble with cigna. They also just charged me over their stated maximum on their Tel Drug. Complete idiots but laughing all the way to the bank.

     
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