Hi all,
Its wonderful to have my life back! And I am excited to report that BCBS did PAY "out of network", which is 60% of the cost of my surgery with Dr. Clavel.
I honestly have no idea why or what we did any differently than anyone else. Possibly it was the documentation? or the fact that I have a Worldwide Blue rider on my policy.
We sent our documentation to Worldwide Blue the last week of Jan. 2013, by Fed EX with a signature required. We included a cover letter detailing my injury and the course of medical treatment and physical therapy that I partook in for the 3 1/2 years after the injury. In the letter we explained that the interim treatments were not working and that I along with my local neurosurgeon began looking for a solution. My Dr. Neuro's final diagnosis was for a two disc replacement (he uses the Pro-disc).
We explained that it was determined that a 2 disc replacement in a SINGLE surgery was best for my situation and that we also had determined that the M6 was best suited for me. (this was based upon our research, my Dr. had never heard of the M-6) We even stated that the M6 had not yet received FDA authorization, but was used successfully and routinely in Europe - specifically Spain- at a fraction of the cost for a single disc replacement in the USA.
We included detailed documentation of everything including a Letter of Medical Necessity from my local Neurosurgeon, copy of the auto accident report which was the cause of my neck problem, copies of paid invoices from BSC, detailed itemization of the total charges related to the surgery, proof of payment, medical reports, copies of x-rays, etc....
It also should be noted that I had 2 plus years of physical therapy, pain management, injections, chiropractor and had exhausted every conceivable alternative to surgery.
We are still in shock - can't believe that we were paid! It should be noted that it took more than 3 months for us to receive the check.
Hopefully, we will see more insurance companies pay for this in the future!
I do not know why they paid or what we did any differently from any one else who has attempted to be reimbursed by their insurance company so I really do not have answers. I will say KEEP DETAILED RECORDS OF EVERYTHING! I even requested copies of my doctor's notes for every visit (do this at the time of the visit as you check out) Also request copies of the radiologists reports for every x-ray, MRI, Myelogram, etc... I have a stack of documentation several inches thick. So keep copies of EVERYthing including hotel bills, dining, travel expenses, EVERYthing!
Hope this helps!