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Old 10-16-2006, 08:35 PM
Nairek Nairek is offline
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Join Date: Apr 2005
Posts: 148
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Quote:
Hmm, wonder if there's a legal precedent set for 'em to uncover.
Well, from what I understand, my OS's secretary was told that it was in BC/BS's contract that they do not cover experimental/investigational procedures. My question is, who are they to determine what is experimental/investigational? As for any legal precedent, I couldn't tell you if there is any at this point. I am studying to become a paralegal and unfortunately I'm not taking any legal classes this semester so I am not able to log into Westlaw to find out that information.

My OS said there really isn't any money in it for an attorney to fight an insurance company about that and it would be difficult to find an attorney willing to spend the time and money on fighting it.

His secretary suggested that I write to my congress person to ask for help in my appeal which is something that couldn't hurt to try. I've been working all night so far looking for peer reviews and information to submit for my appeal.
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----Karin----
Disc Bulge C4/C5, Disc Degeneration T11/T12, Bi-Lateral tears L5/S1, Diagnosed w/ Lumbar Disc Derangement w/ Radiculopaphy. Treatment: IDET, Percutaneous Discectomy, SI Joint Injection, Facet Block. All failed. Empire BC/BS Denied Coverage for ADR-lost all of my appeals. MVP also denied coverage.

ALIF/PLIF Fusion 1/20/09
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