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Old 08-25-2014, 04:03 PM
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henry4956 henry4956 is offline
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Join Date: Oct 2013
Posts: 250
Default Appeal using 'External Review' method

I received a denial on my initial request for reimbursement from Blue Cross World Wide. I had 2 level ADR surgery with Dr Zeegers in April.

There are two ways to appeal a health plan decision:
  • Internal appeal: If your claim is denied or your health insurance coverage cancelled, you have the right to an internal appeal. You may ask your insurance company to conduct a full and fair review of its decision. If the case is urgent, your insurance company must speed up this process.
  • External review: You have the right to take your appeal to an independent third party for review. This is called external review. External review means that the insurance company no longer gets the final say over whether to pay a claim.
Has anyone here used the external review process and if so can you elaborate on your story
Bad fall on A$$, Feb 2001 ice hockey
Lami L4/L5 April 2001, L5/S1 Aug 2001
Severe dislocated coccyx (same fall)
Un-diagnosed til 09. (Cannot sit)
Low back pain mild until 2011 - pull started a generator from knees.
rhizotomy Nov 2011 - zilch
Facet joint inj. 18 mo. (no impact)
Can only stand/walk for approx. 30 min
21 hrs/day in bed
L3-5 Activ-Ls (April 2014) Dr Zeegers - walk every day, swim 3 x week. Pain free, no pain meds. Extremely pleased with my decision
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