Florida Blue - Denied ActivL Lumbar TDR
I had lumbar TDR scheduled February 15, 2017 with Dr. Rolando Garcia in Miami, Florida. Their office submitted for approval and the procedure was denied due to being "experimental/investigational." I then submitted an expedited internal review. Florida Blue had 72 hours to make a decision and I was again denied. This was after I sent in approximately 1000 pages of medical records and my surgeon completed a peer to peer review twice. The first peer to peer was done unfairly (family physician to surgeon). My surgeon then asked for a second peer to peer review with another board certified spine surgeon. Florida Blue again denied the procedure. Today I sent in an Expedited external review. This contained all of my medical records, 25 research studies that favor lumbar TDR vs fusion and all of the insurance companies that offer positive coverage (this includes some BCBS plans). There is another 72 hours to make a decision. If anyone has any other suggestions, it would be greatly appreciated!
Thanks |
you can file a complaint with your States insurance consumer affairs
http://www.myfloridacfo.com/Division...eedourhelp.htm
you can file a complaint with your States insurance consumer affairs |
maybe a lawer or activL® Artificial Disc Patient Assistance Line (PAL):
I found this recommendation for a lawyer that will help with getting insurance to pay from Dr Bertangnoli web site. I am sure it won't be free.
http://www.dr-bertagnoli.com/patient-information.html David Suddendorf, Attorney-at-Law 415.806.6599 dave@davidsuddendorf.com http://davidsuddendorf.com/adr-insurance-reimbursement/ Have you tried the Active L Patient Assistance line? They have staff available to help free of charge. You would have to get your surgeons office to call the them. https://www.soactivesofast.com/low-b...nt-information Resources include: A reimbursement support line for pre-authorization, appeals and external review Template letters, coding guide and supporting literature Ongoing reimbursement landscape monitoring and analysis activL® Artificial Disc Patient Assistance Line (PAL): Monday through Friday, 9:00 am - 6:00 pm ET Tel: 844-245-1140 Fax: 844-285-1330 Email: cynthia@patientassistanceline.com |
Expedited External Appeal Denied
My frustration has continued, as the expedited external appeal that was filed through Florida Blue was denied. This has exhausted all of my insurance options in the United States. Therefore, I will be headed to Barcelona on March 13th to have a lumbar ADR with Dr. Clavel. I have thoroughly researched the neurosurgeons in Germany and Spain and based on patient outcome and insurance provided by Dr. Clavel's office for the surgery, the decision was easy. Also, I have researched the activL and M6L and discussed both discs with several US and European surgeons. In the end, I will go with the M6L. This disc has an 80 year lifespan vs. the activL that has a 30 year lifespan. I feel at peace with the decision and look forward to feeling better in the near future!
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