Check on the Florida Law
Hi Gwin - Be sure that BCBS is in keeping with Florida law. Most states require that any outside medical professional who reviews appeals must be of equal medical specialty as the doctor recommending the surgery. Meaning that if your neurosurgeon is recommending it, a neurosurgeon must review it. Also, ask around in your own community and amongst those who have the same policy that you do. Fusion is so very common these days, that I'm fairly certain you can find someone nearby who is covered by BCBS and has had the same or close to the same surgery. That failing, go to the Insurance Division of your state and file a complaint and ask for an investigation. That may give you at least one more chance to appeal. If so, see The Insurance Warrior's book on line - buy it and check out the appeal form she provides. Very very indepth and she will give you lots of pointers on how to make sure you get covered.
Good luck to you,
Lauren
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Lauren
57yo Female Cervical stenosis with myelopathy
Fusion 2006 C5/6 to address worst of 4 levels
Fall 2009 return of symptoms
Jan 29 2010: 3 level ADR in Bogen Germany by Dr. Bertagnoli -C3/4, C4/5, C6/7 with hardware removal
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