Laura,
Unfortunately, I find myself in the same boat. My first appeal was denied along with BC's suggestion that I utilize the Dept of Managed Health Care independent review. Don't!
I have to assume our denial letters were similar. I found phrases used by BC to be contradictory to their basic statements, on which I based another appeal, along with correcting my medical history. They stated that the Charite disc had equal results to fusion... but stated that fusion is likely to affect adjacent discs. They also stated the obvious that fusion fuses, thereby limiting movement. Thirdly, though not proven in another paragraph, they state that the Charite disc was designed with the purpose of preserving movement.
I pointed these statements out to them along with doctors 'findings' since currently no studies state the Charite's superiority. (I asked Dr. Regan's office for literature but received none) I sent them 2 separate letters, certified, return reciept, but still after one week, they have nothing posted as having been received. Maybe... one could get lost... but 2.
I also stated that it seemed that the costs for the covered procedure, fusion, was similar to the costs for the ADR with the exception of the ADRs themselves and offered to compromise on their costs outside of my policy limits.
Of course, I'm ahead of myself, as they claim red tape in reviewing the letters to which, of course, they haven't replied. I'm also positioning myself for possible litigation/arbitration.
I wish us both, and anyone else in the same battle, good luck.
Dale
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