Hey there the basis of my denial has been EXPERIMENTAL & they do nto care about paying more money for a fusion or for med's. I have a sis in law who works for BCBS ( not in my state) & she too echoes as she is one of those who decides what they will or wont pay. They go for the gold standard fo what the FDA has approved but the procdeutre for a fusion or for ADR in preping the body is the same OTHER than the device so my arguement is pay ONLY for the surgery & NOT the device. Also BCBS has paid for others to have had this surgery BOTH P.D> & Charite so I am saying they can not pay for some & not others. Since my surgery was emminent & medically necessary they would have had to pay for a claim regardless. I am saying if they continue to deny this is my 3rd appeal I will have the expense of an atty ( which they can stall us for some time since they ahve atty's on staff) but when we go to court I will request a jury trial & also request extra money for the time & expense of an atty & the dealy in having them pay. I say pay all but the device of my surgery which was 21,5 K overseas at the International rate- I know it is silly as they would have paid up to 150k for a 2 level fusion - as the level above already herinated & torn would have had to have been included then in a fusion. They already have my MRI info - I am not normal in any of my lumbar discs but again it is NOT what makes good sense but it is whatever they can wriggle out of paying - however the fact is they would have paid more they do not care about. NOR do they care that this procedure gets one up & around sooner etc.
Hope this helps - Jill
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