Artificial Disc Replacement Surgery & Insurance Denial

Your health insurance policy is a contractual arrangement between you and your insurance company. Your policy lists the services that are covered and those that are not. When it comes to artificial disc replacement surgery, your insurance company puts all sorts of limits and restrictions on what they will and will not cover. For example, United Healthcare will not cover a lumbar artificial disc replacement surgery at all. And the insurance companies that will cover artificial disc replacement surgery have all sorts of restrictions on which circumstances they will allow coverage.

Insurance companies are required to provide their covered members with a process for reconsideration and review of any adverse decision or claim denials. By providing the right information according to the insurance company’s policies and procedures, policy holders are often able to overturn a claim denial.

If you decide to appeal, you will need to communicate clearly your reason or reasons for doing so and also be able to produce documentation to support your claim. This might include a Letter of Appeal (from you or your doctor’s office) and a Letter of Medical Necessity (from your doctor’s office), and any other paperwork your insurance company may require.

In instances where new technology is an issue, as in the artificial disc replacement surgery, you may want to include copies of peer-reviewed journals and clinical outcome data regarding the treatment that has been denied coverage.

Questions about Insurance & Artificial Disc Replacement?

Contact the office of Milwaukee spine surgeon Dr. Branko Prpa for information – (414) 939-5447

View All Articles