Cigna denied coverage
 

I need a fusion at S1-L5 and ADR at L5-L4. Cigna denied coverage for both procedures. I plan on purchasing The Insurance Warrior by Laurie Todd. Any other suggestions would be Great!! Thanks!

Get the insurance warrior book. I suggest no "appeals" before you read the book and you have concrete examples of success. There are nuances to insurance that I can not begin to explain.

Cigna's coverage position, for others,
1 level ADR ~OK.
1 level Fusion + 1 level ADR (Hybrid, combined surgery) is specifically excluded in the coverage position the last time I looked.

I asked Cigna about this in an earlier year and they refused to pay for one if I paid for the other to make a hybrid.

ref:
Hybrid construct for two levels disc disease in lumbar spine (full text)

Thanks for the advice. I will read the book before I appeal. The one thing I did think might be of help is that my insurance is actually Boilermakers National Health and Welfare....administered by Cigna. BNHWF state on the Summary of Benefits that they use scientific/medical publications to determine if a procedure is experimental or investigational. I do not know what publications would be considered reputable though or where to find them. I am hoping Laurie's book makes suggestions for this or maybe you would have some knowledge of this. Thanks again!

Appealing
 

Hi Reneen,

I appealed my partner Shay's denial with BCBS successfully even tho she ended up going overseas. I have since become a medical advocate and would be happy to answer questions and get you on the right track.
Have a good day.
Yona

Thanks for the response and desire to help. Not sure where to start or what to ask. I guess first I am not positive I need the extensive surgery the surgeon is suggesting. If he changes the diagnosis, does that bring negative attention to my situation? My insurance says it will cover ADR at one level when non-invasive procedures have been exhausted. I have gone through therapy (last summer but only with a therapist for 3 weeks-she told me I had a very strong core and really didn't need the therapy) I did continue on my own for about 3 months. I also had one shot in the spine and that was a total waste of money. I tried a NUCCA chiropractor for 8 weeks that was also a waste of money. I am sure what I have done will not satisfy the insurances guidelines of non invasive procedures so I am prepared to go through therapy again if necessary. No more shots though...I have read to much that they cause more damage. Maybe we can start with what were the real red flags that you and your partner found and what suggestions do you have for me? Thanks for taking the time to help. I really appreciate it.