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Old 08-28-2011, 06:14 PM
semathes semathes is offline
Junior Member
 
Join Date: Aug 2011
Posts: 6
Default Another newbie denied ADR by BCBS

Suffering with degenerative disk disease at L5-S1. No other issues, 49 years, perfect ADR candidate as per current doctors.
Recently denied ADR by BCBS as usual and as per their policy that not enough history exists to prove ADR is better then traditional (fuse) methods, making this experimental.
I have Insurance Warrior book and have read this forum for awhile now.
Currently scheduled for a second opinion before I decide how much battle to wage.
Options are:
1. Do nothing. Really no longer an option. Pain getting harder to manage and have any semblance of a normal life.
2. Get fused. Limit to movement is no worse than current limit. If trouble develops in adjacent disk pursue ADR at that time and place.
3. Wage war on BCBS. They are more experienced at this than I to say the least. I do not have examples to use of them approving others. I do not have literature to refute there claim that long term benefits are unproven. Perhaps this board can help me.
4. Pay out of pocket (kids college fund).

Questions are numerous. Such as:
1. If I pay myself and have any trouble either now or in the future, I assume BCBS will never cover any remedial work and I could lose the house as well as the college fund.
2. Is it possible to acquire secondary insurance, with this pre-existing, for the sole purpose of covering what I know BCBS won't? Anyone done this?
3. Has BCBS ever approved anyone? If so on what basis?
4. Are there any studies I can use against BCBS's experimental basis of denial? Can the long history of work in Europe be used?
5. What are the best reasons to have ADR as opposed to a fuse?
6. Does anyone have experience involving the manufacture (Pro-Disk) in the appeal process?

I'll stop for now. Glad you folks are here but I'm not hopeful of a positive outcome. Unless a light comes on somewhere I don't now what to do next.

Scott
__________________
2007 lower back pain becomes continuous, original cause unknown
2010 physical therapy, xray, mri, pain meds, muscle relaxers
2011 diagnosed with bone on bone at L5-S1, bone loss occurring, 3x epidural steroids injections, continuous pain meds, ct scan, denied ADR by Anthem BCBS
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