Linx Procedure/ Insurance company approvals

I started this thread so that people who have had the linx procedure or were approved for the procedure could list the insurance they have to let others know which companies are approving the linx. If you could also list the place where you had the procedure done that would be great. For those that were denied please list your insurance company also. I think this will help out those who are interested in getting this procedure.

I will edit this list as people begin to add information on approvals and denials:


Approvals:

sinfrontera - Blue Cross/Blue Shield of Illinois

NoDoubtLove - United Health Care paid for most of the surgery.

Denials:

-Johnboy85 (Cinga open access plus) As of August 2012 at the Mayo Clinic of Jacksonville Florida

Be leery of United Healthcare; they are approving people for the linx procedure but then denying to pay for it.

-Beachgirl and LinxCR were both approved for the linx surgery but once they had the procedure done United healthcare refused to pay for it.

Post Edited (johnboy85) : 3/21/2013 10:42:46 PM (GMT-6)

I believe Blue Shield of CA (BCBS) is approving at USC or so I was told by Dr. Lipham's office.
Anthem is apparently not.

My employer switched insurance from Blue Shield to Anthem. So, I better get surgery done soon. But at least they've promised that all BCBS coverage would stay on as well.

Hopefully those who have had the surgery will chime in and let us know.

Anyone with updates on the insurance for Linx coverage?

Dr. Lipham's office just called me to confirm that no auth is required and hence Linx is being approved for me by insurance. I have BCBS.
I won't know for sure however until I confirm with insurance I suppose.

gerd_hater said...
I have one preop consultation on Tuesday and surgery on Wednesday. They just needed the standard preop physicals done prior to surgery.

I'd choose either Dr. Paul Taiganides or Dr. Horgan if you wanted high volume of Linx surgeries.

The reason I went with Dr. Lipham is (1) a big city is far more accessible to me (I don't drive nor do any of my friends. I don't have family here in the US) (2) As one of the originators he probably has as much info about it as others (3) I feel/hope he does the right thing if he finds any other kinks/hernia in that area.

I'd differ on aftercare for ACL vs aftercare for Linx. With ACL there is a lot of patient specific care and Physical therapy post surgery that needs continual guidance. With Linx, I believe (and hope) it is not as much.

All that being said, if I were to choose now, I'd at least speak to Dr. Taiganides.

 

 

Well I have to stay in Cali for insurance purposes, provided insurance covers it.  I have BSCA same as you.  Good luck on your procedure, I hope it goes well for you.  I would love to hear how it works out as far as insurance and the success of the device if you can find the time to post afterwards.

LinxCR,

I believe the same thing happened to Beachgirl; she also has United Healthcare. I would suggest contacting a lawyer that deals with insurance claim litigation and see if they can resolve it for you since you already had the procedure.

Anyone know if Humana insurance is covering LINX?

RGR

Hi all,

I have UHC-PPO.

From what I understand (please prove me wrong) The Linx is still considered to be experimental BY UHC and they will not cover the surgery and hospital for it at this particular time. They said that each case is reviewed individually, which does not make any sense to me. It's either covered or not covered in the USA.

Beware of insurance companies and the fine print, FWIW.

Gastricman

Gastricman said...
Hi!


Perhaps this thread should be updated, if at all possible.



Thanks,



GM

Good thinking!

I'll post my info from my thread here. I did see today that United Healthcare is billing me for the LINX surgery. They did cover most everything about the surgery - except for the surgeon's bill. They billed me $2,500. The hospital told me not to pay anything on it because they plan on fighting it for as long as needed. Here is a detailed breakdown of what UHC did cover. Sorry if it's too much information but I just want to be crystal clear an helpful for others :)

Here is what UHC paid for on the day of surgery:

Op Misc. Services - they paid: $11,031.94 - i owe: $1,375.77
Operating Room Services - they paid: $5,456.73 - i owe:$606.30
Chest X-ray - they paid: $32.55 - i owe:$1.04
Anesthesia, Abdomen Procedure - they paid: $371.20 - i owe: $63.80
Esophagus Procedure With Scope - they paid:$0 - i owe:$2,500

Grand Total: they paid: $16,892.42 - i owe: $4,546.91 (but $2,500 I hope they will eventually pay!)

NodoubtLove,

Thanks for the information.

The medical biller called back and said this is normal for them to "need more information" and not to worry at all - she'll get back to me when if it becomes an issue and not to pay it. So that sounds good!

On Feb. 11th there were 31 centers offering the Linx; in just one month that number has gone up to 49. There are now 2 additional places offering the Linx in Florida and from what I hear a lot more surgeons are about to be offering this procedure. I hope the insurance companies take notice and change their policies concerning this surgery. It is crazy to think that around 35 additional centers have been added in just the first part of this year. This is great and hopefully this keeps up.