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View Full Version : UHC said NO to BMP surgery. Good Bye everyone - for now



gardenia
09-13-2012, 08:40 PM
United Health Care denied my surgery with Dr Bridwell, he was not very hopeful. I was surfing the web and found many surgeons declaring that 2012 has been more and more challenging as insurance companies are starting to deny any or all surgeries involving BMP or similarly classified as experimental or investigative procedure. Many surgeons posted that PEER TO PEER is a joke as the medical director on the insurance side will make the our surgeons present lots of documention but at the end they will stick to the policy dictated by guidelines.

So, I have asked Dr Bridwell directly if he is dropping me as a patient as I am not to win and waiting is just never ending and not healthy.

I am starting to look for alternative major surgeons that uses other methods other than taking bones out of my body, and apparently taking from cadavers are risky for infection or rejections.

Just moving along... Good look to all of you that still have an opportunity to have the surgeon, it is not for me in St Louis. Back to the drawing board which takes a lot of expense, pain, frustration, and energy.

mabeckoff
09-13-2012, 09:07 PM
I am so sorry for you. BCBS covered my surgery last July which cost over one million dollars. My surgeon used BMP and they just approved my surgery in 2 weeks. Dr Bederman will be using BMP then as well. I hope that you can find some relief

Doodles
09-13-2012, 09:25 PM
Gardenia--
How discouraging! I'm so sorry about this. I wish I had some answers for you. I hope your search will find something promising. Thinking of you. Janet

Confusedmom
09-13-2012, 10:28 PM
What was United's reasoning?

Any chance of switching insurance carriers?

I don't think there is anything for fusion besides BMP, autograft (your own bone) and allograft (cadaver bone). I'm not an expert, of course. But I don't get how they can just flat-out deny.

Evelyn

Irina
09-13-2012, 10:50 PM
I am so sorry to hear that, Gardenia. I, like Evelyn, hope you can switch insurance carriers.

LindaRacine
09-13-2012, 11:09 PM
My understanding is that WashU will pick up the cost of BMP if the insurance company won't pay for it.

tae_tap
09-14-2012, 04:20 AM
Gardenia,

Dr. Gaines in Columbia, MO is a world renown surgeon and specialist is scoliosis and spinal deformities. He does not use synthetic bone materials, but only uses your bone materials. I would encourage a visit with him if you are possible. He. Is out of Columbia Orthopedic Group.

Tamena

susancook
09-14-2012, 05:07 AM
So sorry to hear about that. You were all set and excited. Bummer.
Susan

golfnut
09-14-2012, 05:08 PM
Gardenia,
I truly feel for you. I can't imagine how disappointed and frustrated you are.

hasteffen
09-14-2012, 09:17 PM
I was sorry that I read this post... but I hope you continue with the forum. Best wishes to you. Please keep us updated
Best,
Heidi

osumike
10-22-2012, 10:44 AM
Gardenia, I'm in the same boat. Im self employed, have bad insurance, they said they'd pay about $6,000 toward surgery. What a joke. I was set for surgery with bridwell in 2010 and he cancelled the DAY BEFORE surgery. I never really got a straight answer, but I assume it had to do with money. I feel for you, and know what you're going through. If you make any progress or find something that might help, PLEASE let us know. Good luck.

debbei
10-23-2012, 06:23 AM
I'm so sorry to hear that. Have you gone through the formal appeal process?

jrnyc
10-23-2012, 10:26 AM
i thought i read elsewhere that gardenia got approval for the
surgery....???

jess

gardenia
11-03-2012, 04:17 PM
Jess,
Yes, insurance reconsidered almost immediately.

I am starting a new forum. Sometimes the Header and the date initially posted are misleading.

Gardenia

ScoJo
02-23-2014, 10:36 AM
I am so sorry for you. BCBS covered my surgery last July which cost over one million dollars. My surgeon used BMP and they just approved my surgery in 2 weeks. Dr Bederman will be using BMP then as well. I hope that you can find some relief


I just noticed this post under my Bederman search. I also have BCBS, so it is good to hear they covered it. I am curious about BMP since Dr. Bederman told me he doesn't plan to use it. I will have to follow and ack why.

A thank you to Gardenia who let me know BMP might present an insurance issue.

Irina
02-24-2014, 12:43 AM
Dr. Hu from UCSF didn't use bmp either. She said that there is a mixed data on bmp use - some researchers believe that it might be leading to cancer. She did not see a reason to use bmp in my case and expected me to fuse without it at my age. I was 45 at the time of the surgery.

ScoJo
02-24-2014, 09:18 AM
Dr. Hu from UCSF didn't use bmp either. She said that there is a mixed data on bmp use - some researchers believe that it might be leading to cancer. She did not see a reason to use bmp in my case and expected me to fuse without it at my age. I was 45 at the time of the surgery.

Wow, good to know so that I have that information to consider. Thank you!

gardenia
02-24-2014, 01:02 PM
I just received a notification of activity to this thread that I thought was no longer active. For many months, I have been looking how to start a new one on several issues and could not.

Brief update.
I got approval by UHC with the help of Dr Bridwell. Surgery was Nov 2012 was very successful. A predicted dural cut during the procedure happened and was fixed and had to remain sedated another 72 hours to leave the hospital 10 days in total due to bowels not working.
Recovery went well until about 5 months later when I started problems with digestive problems (May 2013). Was in St Louis for my 6 months check up and found that I was losing my taste for food.

By the time of my one year check up (Nov 2013), I had seen 2 GI specialists and they declared that I have Eosinophilic Gastroenteritist. Placed on Prednisone which Dr Bridwell was very concern but had to be. Dr Bridwell was concerned about my 20lbs lost but I was happy for all the extra fat around except my tummy did not lose.

My tummy is constantly having inflamation problems. After the Prednisone treatment for 2 months, I was well for about 2 months and now all the symptoms are returning. Fortunately, I will see the doctor tomorrow (Feb 25, 2014)

During my visit to Dr Bridwell (Nov 2013) he mentioned having 3 patients in the past that had a similar situation like mine but a bit more severe with all my symptoms and it was diagnosed to be a rare disease: Chronkite-Canada Syndrome which now after having my 3rd set (in 6months) of Endoscopy/colonoscopy and no decrease of eosinophils - the lab report is suggesting into looking at this condition. Otherwise, everything else is OK no malignancies, polyps are benign, no parasites or any other icky stuff.

I thank this forum for being always so very supportive.

gardenia