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| The Big File All issues not easily categorized in the above forums are here. Comments on general health, diet, "getting comfortable," and more are here. |
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#1
03-20-2005, 10:18 PM
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I am beginning my first appeal with BC/BS of Oklahoma. Just wondering if anyone close to me had any luck with BC/BS yet. It would help those of us in the appeals process to know of others that were successful in their approval process.
I'll start it off: Oklahoma BlueCross/BlueShield denied-"experimental" 3-7-2005 currently in 1st level appeals process Thanks for any info you guys have.
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L5/S1 Ruptured DDD 
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#2
03-20-2005, 10:33 PM
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Mine paid 60% of everything. Blue Cross, California.
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Back pain began Jan 18th 2000 no trauma MRI revealed severe DDD L5 S-1 with a 7mm disc bulge Microdiscectomy/Lami Oct 12th 2000 Leg pain resolved, but back continued to be painful Neck pain began Feb 2003 no trauma MRI revealed DDD level C6/7 with a disc bulge C spine fusion done on Aug 14th 2003 Still needed lumbar 2 level fusion, ugh Met Dr Rick Delamarter, entered trial 2 Level Prodisc completed Aug 12th 2004 Now (2011) experiencing numbness and heaviness of both legs
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#5
03-22-2005, 09:12 PM
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BC/BS of NY (now Empire Health Choice) authorized a two-level ADR w/Regan in LA. In their small print they say that they can deny this too. Haven't had the surgery 'tho so can't say how things worked out.
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Severe, extensive DDD, considered inoperable by Dr. Regan, Lauressen, & some guy at UCLA. Severe foraminal stenosis (guess they can't operate!) and some spinal cord compression that Lauryssen would fix if gets outta hand.
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#6
03-29-2005, 09:54 PM
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Does anyone know if CIGNA Open Access Plus pays for Charite?
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1996- fell out of a tree, injured lower back. Physical Therapy for years. MRI's, CT scans. 6 epidurals, nerve block, discogram. March 11, 2003 discetomy surgery April 15, 2005- insurance denial. Starting the appeal process.
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#7
03-29-2005, 11:52 PM
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I know of a person here in Colorado that had CG Open Access Plus and they paid. Connecticut General is affiliated with CIGNA.
I have CIGNA HMO and they have denied so far. Brady
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15+ yrs chronic low back pain. L5/S1 DDD
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#8
03-30-2005, 06:40 AM
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Thanks Brady, you gave me some hope of them approving. I am starting to get depressed. I should "hopefully" know something on Friday. But these dr. offices are taking their time. Good Luck to you all.
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1996- fell out of a tree, injured lower back. Physical Therapy for years. MRI's, CT scans. 6 epidurals, nerve block, discogram. March 11, 2003 discetomy surgery April 15, 2005- insurance denial. Starting the appeal process.
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#9
03-30-2005, 07:50 AM
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Can anyone tell me why in different states the insurance companies are approving and not approving of the surgery? I have cigna open access plus and I read a lady in L.A. has the same thing but was denied and then someone told me someone in Colorado has it too and was approved. What's the difference?
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1996- fell out of a tree, injured lower back. Physical Therapy for years. MRI's, CT scans. 6 epidurals, nerve block, discogram. March 11, 2003 discetomy surgery April 15, 2005- insurance denial. Starting the appeal process.
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#10
03-30-2005, 08:30 AM
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Cavalib,
Each insurance is differant between state to state and eventhe same inusrance company in the state will differ between differant employers. it really makes things hard on us. I don't think it is fair or correct but my wife works in a hospital dowin this kind of stuff and she says this is how it is. I just found out mine is approved but I feel guilty and bad that others are ahving to go thru this. It just doews not make sense to deny anyone this. I wish you and everyone else the best in trying to work this out. Don't give up!! Dave
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87 Lam 88 Lam no help. 11/12/04 was told I needed fusion at 2 levels L4/5 & S1/5, ADR Surgery date was 5/13/2013 with Dr. Bertagnoli had fusion on S1/L5 and ADR on L5/L4. it is now 8 years post surgery and do not even take an aspirin for my back.
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