I won my appeal with BCBS!!!

[Andi Lea]

Please PM me and give me your email so I can send my appeal/rebuttal as an attachment.

I researched for about 4 weeks before I wrote my appeal. In my appeal, I took the angle of challenging their policy against ADR by focusing on their definition of "investigational" and deconstructing that. As far as using court cases, I used two: Danica Dubaich vs. Connecticut General Life (CIGNA) and Juliana Antonelli vs. South Carolina Budget & Control Board. I was denied 3 weeks later based upon my double level DDD and retrolisthesis. I had a few days to submit material regarding my denial. In my rebuttal, I focused on the CIGNA case and how that case ruling established a new US standard for multiple DDD & ADR; BCBS's outdated material they used which is no longer current nor accurate; the expert opinion of my surgeon against the opinion of the medical director over my case. My surgeon also submitted a letter. The next day my denial was overturned.

Once I hear from you with your email, I'll send my appeal/rebuttal. I wish you the best in your appeal.

[Andi Lea]

I went last week back to Dr. Guyer at TBI for my 8 week post op. He took X-rays and said everything looked good.

I am still experiencing pain in my lumbar area as he said I would. He reiterated that was expected for the first 3 months considering how collapsed my spine was. In physical therapy, I need to concentrate on core strengthening and stretching the facet joints. I'm still to avoid bending beyond 30% and twisting. He said twisting was too stressful on the facets. The pain I experience is not constant, but in conjunction with transition movements and standing/sitting straight up. He said that after 6 months, whatever pain I still experience is likely to be permanent.....not a hard-fast rule, but it has been his observation.

My friends ask me if the pain I now experience is less than the pain I experienced before the surgery. Before surgery, I never experienced pain from the large nerves. My pain was discogenic meaning it involved the small nerves right around the L5-Sl area. Thus, my pain came with certain movements and was always localized. My current pain is still with certain movements and is still localized in the same area, but it feels different in that it is not a burning sensation but more of an intense ache. Again, it's not a constant ache - just in conjuction with certain movements.

I will update again after my 3 month post-op visit.