Current Lawsuit against Blue Cross Pro-Disc Denials ( Help Wanted )

[Berylcooks]

We are currently beginning a suit against BC/BS for the denial of coverage for Pro-Disc L.

Would love to connect with others who have been denied coverage for this FDA approved procedure.

[haayers]

Just starting out on this journey. My husband is a candidate for surgery, so I called BCBS and read them the CPT codes the surgeon gave us. They told us it is not covered. They considered it "experimental". What? The FDA approved it, right? Makes no sense to me. Really frustrated right now....don't know how we are going to get this surgery done, except to pay out of pocket. Incidentally, I happen to work for BCBS so it's a rather sticky situation for me to be in.....

[Berylcooks]

would you like to join us and work to remedy this?

we went through the appeals process (first, second and third) and ended up paying out of pocket. good news is our son is now much better. please contact me if you want additional information,

[Harrison]

Beryl, there may be some confusion about the "join us" part of your question. Can you spell out what you mean by this please?

Thanks!

[haayers]

Yes, I was just about to ask that. What do you mean by join us? Like I said in my reply, I work for them, so I need to tread lightly on what I do/don't do. But, yes, we need them to pay for this surgery! We've gotten an estimate from the Dr. that it'll be approx. $100,000 to pay out of pocket. We also found a high risk pool that would take my husband w/ the pre-existing condition, the insurer is Healthnet. Anyone have any experience with Healthnet HMO? Not sure if this is the right thread to ask, or if I'll also open up a new thread.

[sahuaro]

I had HealthNet PPO and they absolutely did not cover my ADR surgery--the appeals process was a joke...

[Berylcooks]

what we mean is to get stories and people together-right now we are investigating this. we are going forward in a suit-whether or not other choose to join us...who knows? hope this clarifies.

[VegasTech702]

I just had a cervical ADR at c4-c5 in July and BCBS of IL covered it. It took a lot of cooperation from the doctors assistant and a lot of my time and a huge phone bill but we were able to get it resolved.

Why would they cover cervical but no lumbar? Now I am needing a lumbar ADR and we have not yet submitted for preapproval yet. I hope this doesn't mean am going to face a brick wall...

[beasage03]

Join us as in doing a class action lawsuit?

[jamie5136]

You will lose against BC, I did, plus, I did a three level ADR in Germany and am disabled now; worse than before. Think first and do more research about Pro-Disc L. It ruined my life. I was young and successful; I know feel old and bitter and poor. 2 of the 3 sank into my bones; I can't sit/lay down; pains all over. I did my research too, but it truly is experimental, in my opinion. If I had to do it all over again, I would have had a fusion at 2 of the levels and maybe an ADR at one. Read about subsidence (mine did and I don't have a bone issue) and read about facet issues.... read about how to remove if it goes bad; you can't really w/out much risk.