Another question whose answer is already posted on this forum...
This is what I found out after researching and reading within this forum and emailing members over a period of a couple months:
Insurance companies are *not* organized on a national basis (for the most part). They are set up independently on a localized basis which can be state by state or within multi-state regions and sometimes even more fragmented than that. They are also administered differently, depending on who is being insured or how large the ensured group is, and this varying administration means that different entities sometimes make the final decisions on appeals. Some are self-funded and separately administered and some are not. The upshot of these disparities is that what a BCBS in Washington State does has practical bearing (and sets no recognized precedent) with what a BCBS in another state does. They are not connected in any way which is subject currently to overall national legal remedy and they are certainly not connected in an financial way, other than that they share a common name and some varying franchise benefits from the parent entity, who is not liable to the insured (check your statements of policies or brochures - BCBS is always careful to put that wording right on the cover or first page of every brochure).
This is the sad condition of our current national insurance legislation and until something is done (on a national level) to force insurers to: 1 - pay for all FDA approved procedures, and 2- accept a single, unified description of policies and responsibilites across state and separate company lines, we here at the ADR Support Forum (and all other residents of this country who are medically insured) are left with wrangling with them on a company by company basis.
As this group become larger in numbers and more members post their successes with specific state-located companies I hope insurance will become much less of an obstacle for those seeking ADR. This is why it is vitally important for every member who has finally obtained ADR through insurance to post their details. As each member gets compensation for ADR from their individual insurer and posts specifics about how they worded their pre-certs and appeals, the next member down the line from the same state and insurer will be able to reference the successful member's information and short circuit the insurance industry's zeal for denial.
On a specific note to Danielle: If BCBS Washington State told you they didn't have an answer then they were lying or you talked to the wrong person!
Here's the link Danielle was referring to:
http://www.depuyspine.com/about/about.press.040605.asp
The title, if I were to post the article in our Articles Library, would be "Blue Cross Blue Shield (BCBS) New Jersey Approves Payment for Charite Artificial Disc".