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Insurance Hell All insurance-related matters are here: Medicare, worker's compensation, appeals, denials, insights, wins, losses. PRICING is here too. Note: This forum has posts from 2006 forward. Older ones are in the Big File. |
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BC/BS of TX
Well, it seems I've gotten denied by BCBS of TX for ADR surgery, based upon their opinion that the surgery is still experimental. I spent a great deal of time on the phone with them, asking for supervisor after supervisor, until I was finally forwarded to somebody who made sense. It seems that they will consider covering my ADR surgery if I can provide them with appropriate medical literature that proves it is safe and effective. Has anybody here had any success with this route? If so how?
I will continue with this thread, posting article references I find in favor of ADR, so as to help anyone else out who may be going through the same ordeal. If anybody has any insight or other references, I would be grateful for them as well! |
#2
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They are probably banking on the fact that no one will be able to come up with what they are looking for. Turn them on to the success stories here.
My 4 level was covered by Blue Cross of Michigan. They did right by me and I swear by them as they have insured my company for 20 plus years. I hope you get what you need here. Terry Newton
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1980 ruptured L4-L5 1988 ruptured SI-L5 1990 ruptured C5-C6 1994 ruptured C6-C7 1995 Hemi-Laminectomy C5-C6, C6-C7 Mayo Clinic Bicycle Accident 2004 MRI, EMG, Facet Injections, Epidural Blocks, Lumbar Discogram. Stenum Hospital Surgery November 4, 2006 Prestige Disc C5-C6, C6-C7 Maverick Disc S1-L5, L4-L5 |
#3
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Will do! It's encouraging that you got BC/BS to cover your surgeries! How did you do it?
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If it was not for a board member, who sells BC/BS insurance, asking them for a special review of my case I don't think they would have covered it. I have been the executive director of this company for 18 years and the board member believes in me greatly. It's nice to have friends in high and low places.
Terry Newton
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1980 ruptured L4-L5 1988 ruptured SI-L5 1990 ruptured C5-C6 1994 ruptured C6-C7 1995 Hemi-Laminectomy C5-C6, C6-C7 Mayo Clinic Bicycle Accident 2004 MRI, EMG, Facet Injections, Epidural Blocks, Lumbar Discogram. Stenum Hospital Surgery November 4, 2006 Prestige Disc C5-C6, C6-C7 Maverick Disc S1-L5, L4-L5 |
#5
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Quote:
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Tags |
adr, appeals process, blue cross, blue shield, journal articles |
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