Thread: BlueCard WW
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  #11  
Old 08-22-2014, 01:49 PM
Optimistic Optimistic is offline
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Join Date: Mar 2014
Posts: 81
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Henry....sorry to hear that you were denied, though this is only Round 1. It appears that not only did BCWW disagree with the "medical necessity", which your Doctor clearly wrote in his letter, but they tie the medical necessity to "the type of service rendered". This implies that you did need treatment but may not have needed ADR. This is just my take on the denial. For example, if you had obtained fusion surgery, BCWW may have approved this "type of service" as a medical necessity.

I wish you luck in the follow-up appeal. I am quite interested what other members like yourself include in follow-up appeals when their first application or appeal is all inclusive. Does anyone have thoughts on this?
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1989 – herniated disc at L5-S1
1992 – L5-S1 broad bulging; right L5 nerve root compression; impingement on S1 root within spinal canal;
2006 – DDD L3-S1; disk bulge at L3-L4 and mild facet/ligmentous hypertrophy; L4-L5 large herniated disc; facet/ligmentous hypertrophy with stenosis; disc herniation & dessication at L5-S1;
2013/2014 – Dessication and significant disc height loss at L4-L5 & L5-S1; L3-L4 disc bulge with hypertrophy; mild spinal stenosis; Grade 1 anterolisthesis (3mm); L4-L5 - marginal spurring and moderate hypertrophy causing neuroforaminal narrowing; L5-S1 - moderate-severe neuroforaminal narrowing; lumbar lordosis is straightening.

New pains & functional limitations in late 2013 led to exploring ADR procedures. Consulted with 8 surgeons domestically and 9 in Europe.
May 2014 – Anterior and posterior incisions in a 5-hour surgery resulted in 2 M-6s and one facet joint prosthesis (dynamic stabilization system). On the road to full recovery.
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