Thread: Final appeal
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Old 08-01-2014, 10:43 PM
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Kelly4ADR Kelly4ADR is offline
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Join Date: Jan 2014
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Default BCBS Idaho medical policy cervical ADR

I looked up the medical policy intervertebral discs cervical for your insurance. It looks like you have to jump through some hoops and it does say you can have one disc replacement if you have SCDD (symptomatic cervical disc degen) at only one level, not multiple. It doesn't say you can't have DDD at other cervical levels, just no other symptomatic cervical levels. So, being that it looks like they want all kinds of documentation to approve one level, have you had any tests to conclude, with all certainty that your symptoms are from that disc? Like a discogram? It seems like if you could prove the other levels are not producing any of your symptoms they don't have a reason to deny. That doesn't mean they won't, though...rarely does it make sense what they do
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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
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