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Old 09-28-2018, 10:57 PM
megatron-adr megatron-adr is offline
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Join Date: Jul 2016
Posts: 8
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My journey to get two level Mobi-C pre-approved through insurance was an absolute nightmare. The first submission for pre-approval with Anthem went through the Peer-Review (denied). The surgeon had me use a 3rd party appeal consultant that was sponsored by LDR (mobi-c mfg at the time) to attempt to get the appeal through and that 1st Level Appeal was rejected also. I was debating whether to go forward with the Final Appeal, but then decided to go visit TBI in Plano and see Dr. Blumenthal.
My thought was I would likely end up having to pay out of pocket for the surgery and they were the most experienced and reasonably priced here in the US as best as I could tell at the time (late 2016). Ultimately he thought there was no reason insurance should not approve this and his office submitted for pre-approval. It was approved within a week after a two months of constant follow up and jumping through hoops with the other submission and appeal process. Long story short.... sometimes it is not the procedure that is getting rejected, but I think it is the hospital system or the way the claim is written up that triggers a rejection.
My lesson learned.... if insurance declines it through one system... try a different system with a different surgeon. It is interesting how things sometimes workout for the best as I truly beleive I was meant to get the surgery at TBI by Dr. Blumenthal vs the original (closer to home) location.
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