Colorado Babe,
Thank you for taking the time & effort to list the articles and share your letter. I was denied pre-approval (from Cigna, not Tricare) for a 3-level hybrid lumbar procedure (2-level ADR & 1-level fusion) & ended up going to Europe for a 3-level motion preservation procedure. Instead of filing an appeal, I decided (with the input of my surgeon's office) to file a new claim based on what was actually done.
Rather than filing all of the reasons why they should approve, I will keep all this data in my back pocket in the event they deny the claim. At that time, I can focus on the reasons for the denial and prepare a comprehensive appeal.
Thanks again for your support. Good luck on your procedure next month, October 20th if I recall.
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1989 – herniated disc at L5-S1
1992 – L5-S1 broad bulging; right L5 nerve root compression; impingement on S1 root within spinal canal;
2006 – DDD L3-S1; disk bulge at L3-L4 and mild facet/ligmentous hypertrophy; L4-L5 large herniated disc; facet/ligmentous hypertrophy with stenosis; disc herniation & dessication at L5-S1;
2013/2014 – Dessication and significant disc height loss at L4-L5 & L5-S1; L3-L4 disc bulge with hypertrophy; mild spinal stenosis; Grade 1 anterolisthesis (3mm); L4-L5 - marginal spurring and moderate hypertrophy causing neuroforaminal narrowing; L5-S1 - moderate-severe neuroforaminal narrowing; lumbar lordosis is straightening.
New pains & functional limitations in late 2013 led to exploring ADR procedures. Consulted with 8 surgeons domestically and 9 in Europe.
May 2014 – Anterior and posterior incisions in a 5-hour surgery resulted in 2 M-6s and one facet joint prosthesis (dynamic stabilization system). On the road to full recovery.
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