Please PM me and give me your email so I can send my appeal/rebuttal as an attachment.
I researched for about 4 weeks before I wrote my appeal. In my appeal, I took the angle of challenging their policy against ADR by focusing on their definition of "investigational" and deconstructing that. As far as using court cases, I used two: Danica Dubaich vs. Connecticut General Life (CIGNA) and Juliana Antonelli vs. South Carolina Budget & Control Board. I was denied 3 weeks later based upon my double level DDD and retrolisthesis. I had a few days to submit material regarding my denial. In my rebuttal, I focused on the CIGNA case and how that case ruling established a new US standard for multiple DDD & ADR; BCBS's outdated material they used which is no longer current nor accurate; the expert opinion of my surgeon against the opinion of the medical director over my case. My surgeon also submitted a letter. The next day my denial was overturned.
Once I hear from you with your email, I'll send my appeal/rebuttal. I wish you the best in your appeal.
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years of bending from pottery profession
lumbar pain since Aug. 2012
MRI findings: DDD at L2 & L3 w/mild retrolisthesis;
DDD at L5 & S1 w/loss of disk height & w/desiccation
surgeon recommends ADR at L5 & S1
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