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Old 08-29-2011, 08:57 PM
semathes semathes is offline
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Join Date: Aug 2011
Posts: 6
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Nice to hear from caring people who know what this is like.

My insurance is Anthem BCBS through my employer. They just changed to Anthem 1/1/11 so if I would have not tried to live with the condition the last couple of years I might have been covered. Hindsight now.

I'm waiting for another appointment and second opinion. I tried to get the best ADR man around. He claims to have done the most in Houston and teaches others the procedure. However he does not appear to be adamant of ADR vs fusion, at least not enough to help fight Anthem. Waste of his time I guess.

My pain management Dr is adamant however. She says I'll be seeing her again if I get a fusion. She also has said I need to switch insurance companies. Not easy to do with employer provided family coverage.

I think the worst part is trying to figure all this out, pain treatments, PT, the DRs, which method of repair, the insurance issues, grounds for appeal, how much time can I wait, on and on, without knowledge or help, while working, raising a family, living in pain. I would pay someone to help get it handled if such a person existed.

I'm also wondering what Anthem's deal really is? If ADR is cheaper, or at least not significantly more expensive typically, the recovery is quicker, the risk of additional issues decreased etc etc why would Anthem not allow ADR? If they only care about the money, as we know they do, then why not allow ADR? It would make more sense if the ADR cost significantly more. And why would others (Aetna, Cigna, some BCBS) who are also only calculating the dollars have figured it differently?
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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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