Quote:
Originally Posted by Renee
I need a fusion at S1-L5 and ADR at L5-L4. Cigna denied coverage for both procedures. I plan on purchasing The Insurance Warrior by Laurie Todd. Any other suggestions would be Great!! Thanks!
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Get the insurance warrior book. I suggest no "appeals" before you read the book and you have concrete examples of success. There are nuances to insurance that I can not begin to explain.
Cigna's coverage position, for others,
1 level ADR ~OK.
1 level Fusion + 1 level ADR (Hybrid, combined surgery) is specifically excluded in the coverage position the last time I looked.
I asked Cigna about this in an earlier year and they refused to pay for one if I paid for the other to make a hybrid.
ref:
Hybrid construct for two levels disc disease in lumbar spine (full text)