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-   -   Florida Blue -Post C5/C6 Denial (https://www.adrsupport.org/forums/showthread.php?t=13555)

Nestletea 11-26-2016 09:45 PM

Florida Blue -Post C5/C6 Denial
 
For those of you struggling with insurance authorizations, I wanted to share my story regarding the mobi-c C5/C6 disc replacement surgery I had on 3/17/16. My neurosurgeons office failed to receive prior authorization and the surgery was denied after the fact. Imagine the surprise when I opened a letter from Florida Blue stating that the cervical surgery had been denied due to not being medically necessary. I had been through months of conservative therapy (chiropractic, PT, and pain management). I had severe weakness in my right arm and wrist extensor, which was confirmed by a NCV/EMG. The neurosurgeons office tried to appeal the insurance decision several times and failed. Ultimately, I ended up filing my own appeal. The mobi-c patient advocacy group was extremely helpful in providing research documentation to send in with my appeal. My chiropractor and physical therapist both wrote letters on my behalf. Guess what? I won my appeal on the first attempt. I would be more than happy to share how I put my packet together if anyone needs help.

Harrison 11-27-2016 11:03 PM

Congrats
 
That's great news! Continued success on your healing. Pls remember to take good care of your teeth and gums for the rest of you life! Yes, it's all related....:shedance:

Pls see my biofilm channel, there are several on the dental-systemic connection:

https://www.youtube.com/user/ADRSupport/videos

WakesurfMike 12-09-2016 08:08 AM

I would like a copy of what you submited
 
I would like a copy of what you submitted. My Dr just submitted for authorization to Blue Cross. I am expecting to receive a denial

WakesurfMike 12-21-2016 10:03 AM

Update. I actually got approval on first request with Anthem Blue Cross
 
Update. I actually got approval on first request with Anthem Blue Cross

pittpete 12-21-2016 06:18 PM

Awesome:beer:

nginla 04-17-2018 07:00 PM

Hi - I had an L4-5 ADR with Dr. Clavel 4 months ago. Filed the international claim with BCBS, who sent it to my local BCBS of MN who denied it all saying it was not a medical necessity and that the procedure is therefore not approved. Can you please share with me how to go about the appeal process? I will really appreciate it. I am trying to get as much information frm all successful appeal candidates so that I put the package together as best as possible! It appears I cannot private message you. Thank you,

GravyBaby 04-17-2018 08:35 PM

Hey Nestletea,

Did you get BCBS to pay for your lumbar disc with with Doctor Clavel as well?

Best,


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