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Old 03-22-2014, 10:21 AM
cruiser cruiser is offline
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Join Date: Jan 2014
Posts: 13
Default BCBS reversed their denial and paid for multi-level cervical ADR!!

Success. After my out of pocket trip to Germany for two new shiny M6-C's I was denied payment by BCBS. I put together a 40 page binder full of clinical studies, white papers, and medical journal articles. I had them professionally printed, and bound. There was a cover letter, as well as a table of contents included.
BCBS reversed their denial and cut me a huge check.
Surgery was September 2013. Denial at the end of December was for "medical tourism" and "experimental procedures". In January I started my research for appeal and sent the reports with request for reimbursement. After many phone calls in the intervening months I was approved at the first level of review and the check came in mid-March 2014. No lawyer, no advocate, just some time on the internet and a little perseverance. I am elated!
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C 3-4-5 fusion circa 1981
2 Spinal Kinetics M6-C's at C 5-6 and C 6-7
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