[FranklySir]

B,
after care insurance was optional on the first surgery. I think you can opt out but on my lumbar it was on the quote probably so two quotes don't need to be generated but not sure. For me it was peace of mind and would still do it and did on the second surgery as well.
I agree with all of your list. I would however list the conservative or the treatment path in a general sense not as in like legal ease.
Only in the event that you are NOT seeking Preauthorization. You are seeking preapproval with BCWW so the Letter of necessity should suffice if they authorize up front. the conservative listing works when asking after you have paid without approval.

You are right IMO that hold some back just in case you need to appeal but too much that it has to be appealed. Fine line.

Mine was 11 documents plus the synopsis. Card copy like you said not needed/ just your member number.

Like this: synopsis but leave wiggle room as in from memory on some items. remember they have access to most of your records if you have been with them. short enough to get them to actually read it and long enough to cover the points.


July 2013
PCP ordered MRI
PCP Or surgeon course of oral steroids
Attended PT ordered by Surgeon
Pain Management by PCP or orhto list meds

August 2013
Oral steroids
COntinued PT and pain management
Surgical appointment
Surgeons assessment fusion and get opinion on ADR
Met with PCP to discuss ADR and he/she agrees that I would do well blah blah

Laying it out like this shows you have exhausted all conservative treatment
backing up medical necessity without saying it.

So we shall see since i will submit in the same fashion as before. not sure really what the magic was but being matter a factly mostly and lastly humanize yourself I think was key. The rest is just numbers and billing factual info. Complaining and making it a bad read turns these guys off and they just put it down. Iwould be careful not to put in their face their own documents. It shows you read them and the wording can trip you up especially given your case that your are getting a Preauthorization. Its either yes or no. Or am i wrong?