In my experience, it seems like the only people "approved" or won on appeal are people VERY early in the process before ins companies realized it was going to become so "popular"; or they were approved because the dr put though an ins code making it appear it was fusion rather than ADR (before current approved ADR codes); or they have a self insured insurance plan and have been extremely lucky to have an employer willing to override the third party administrator's automatic denial; they are a federal employee and they used the FEHB policy as grounds to override private ins companies policies; they've paid out of pocket and sued afterwards, or they have Aetna.
I'd love to hear about someone with BCBS, Humana, or UHC that's recent, and won on appeal that's not a self insured situation, pay out of pocket first, or federal employee situation!
good luck
__________________
Injured 9/01
Annular tears L4/5 & L5/S1
denied adr by insurance for 2 level charite as well as hybrid fusion at L5/S1 with Charite at L4/5.
New ins paid for 2 level lumbar prodisc surgery on 4/7/08 (at age 39) with Dr. Westerlund, at Core Orthop
|