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Old 11-26-2016, 08:45 PM
Nestletea Nestletea is offline
Join Date: Nov 2016
Posts: 33
Default Florida Blue -Post C5/C6 Denial

For those of you struggling with insurance authorizations, I wanted to share my story regarding the mobi-c C5/C6 disc replacement surgery I had on 3/17/16. My neurosurgeons office failed to receive prior authorization and the surgery was denied after the fact. Imagine the surprise when I opened a letter from Florida Blue stating that the cervical surgery had been denied due to not being medically necessary. I had been through months of conservative therapy (chiropractic, PT, and pain management). I had severe weakness in my right arm and wrist extensor, which was confirmed by a NCV/EMG. The neurosurgeons office tried to appeal the insurance decision several times and failed. Ultimately, I ended up filing my own appeal. The mobi-c patient advocacy group was extremely helpful in providing research documentation to send in with my appeal. My chiropractor and physical therapist both wrote letters on my behalf. Guess what? I won my appeal on the first attempt. I would be more than happy to share how I put my packet together if anyone needs help.
1/8/2016 - Microdiscectomy L5/S1
3/17/2016 - Cervical Disc Replacement C5/C6 (Mobi-C)
10/19/2016 - DeKompressor Wand L5/S1
1/16/2017 - Cervical Radiofrequency Lesioning
3/15/2017 - Dr. Pablo Clavel: Cervical Disc Revision C5/C6 (M6-C) and Lumbar Disc Replacement (M6-L)
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