Hello,
I am currently appealing Aetna for a two level cervical. This is my third and final appeal over the last 6 months. The determination is due to come no later than Aug 9 via a letter in the mail...
I'm not completely familiar with BCBS ' appeal process. How many appeals have you sent so far and what did they include? Were they all denied for the same reason or did they change reasons? Has your surgeon been involved in the appeals process? Their denial doesn't make sense, unless you haven't met some criteria, for example, Aetna states you must have failed at least 6 weeks of conservative therapy...
I also have multiple cervical levels (5) but I need a two level replacement at c5-7. Do you know what prosthetic your surgeon is requesting? Are you sure his CPT codes didn't include more than one level? It sounds like the denial is for requesting multiple levels??
I have been blessed to have a company...MCRA... Handling my case and submitting appeals on my behalf, as well as my surgeon. If you want to send me a PM with your email I am happy to share my appeal documents with you.
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2004 MRI -cervical bone spur causing pain
2011 MRI -5 bulging discs at C3-7: Recommended C5-6 and C6-7 for a two level fusion, I said no thanks.
2014 MRI -progressive compression C5-7.
MRI 6/5/14- Ruptured L4-5, bulge at L2-3 and L5-S1 Dr recommends discectomy of L4-5 but won't do surgery until cervical is stable
8/2014- 8 months/3 rounds of appeals, Aetna denies 2 level cervical ADR 
2 level ADR w/ mobi-c C5-7 Jan 7, 2015
Last edited by Kelly4ADR; 08-01-2014 at 10:47 PM.
Reason: I hate typos
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