Hey Big Red,
Last year I went through an external review with the CA Dept of Insurance for a 2 level Charite. They upheld PacifiCare's denial as "investigational and experimental."
More recently I've tried to get approved a hybrid (fusion at L5/S1 and Charite at L4/5) . When I called Pacificare to follow up...they said the surgery was denied. When I got the copy of the denial letter it only referred to the Charite and said nothing about the fusion. I made them clarify what their position was on the fusion part of the surgery. It only took the assistant an hour or two to review my file with the medical director and get back to me with an approval of the fusion half of the surgery...but they continued to deny the Charite part. I am appealing with CA Dept of Ins on this now.
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Injured 9/01
Annular tears L4/5 & L5/S1
denied adr by insurance for 2 level charite as well as hybrid fusion at L5/S1 with Charite at L4/5.
New ins paid for 2 level lumbar prodisc surgery on 4/7/08 (at age 39) with Dr. Westerlund, at Core Orthop
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