Thanks Beth. I appreciate it. I have not yet ordered the video, but I did get Laurie Todd's book and CD. (The Insurance Warrior). I read the book cover to cover the first night that I got it. It's a great book and lays out a blueprint for successful appeals in a very succinct and plausible manner. Her own personal story is incredible....as are the cases that she has helped people to win. No doubt.
My issue unfortunately is that I have Blue Cross/Blue Shield and from what I can ascertain, they simply do not approve disc replacement surgery. Period. I have spoken at length with 3 neurosurgeons over the past month and they each have laid out a very compelling case that a battle with BC/BS for a 2 level ADR will ultimately cost a lot of time and heartache....and in their opinion (based on their own experiences in their own practices) will end with a flat-out denial. In fact the last NS that I saw relayed that the latest literature from BC/BS stated that they will only entertain covering ADR's when there have been 10 year trials completed. We're at least another 5 or 6 years away from that. I don't have that long. I've been living with chronic, debiliatating pain from my last surgery for 10 years and I'm at my wit's end. I don't have another 2 or more years to try to win an appeal. And I certainly don't have another 5 or 6 for a "maybe". Of course the other option is heading to Germany, but I simply don't have the $40K-$50K that it would take. It truly is overwhelming.
I've spent an awful lot of time researching the ins and outs of ADR, but have yet to do the same for 2 level lumbar fusions. I am starting that process right now as it appears that this will be my only shot at getting some relief.
Unless of course there's anybody out there who has proof that their Anthem BC/BS PPO plan in CA approved a 2 level ADR....??? I may be missing something and my doctors may be missing something too, but I have yet to see that precedent set.
It's enough to make a grown man cry. Sorry...just feeling a bit disheartened today.
