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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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Old 05-24-2021, 07:00 PM
1Day 1Day is offline
Junior Member
Join Date: Oct 2013
Posts: 27
Default Blue Shield of CA Double Lumbar ADR

Shocker...looks like Blue Shield of CA now lists double lumbar ADR as an approved procedure, page 4!!! Might be time to change insurance.
Back and Neck Pain 30+ years, Chiropractic care
Several Epidurals and Blocks over past 5 years
Awaiting Insurance for 2 ADR Lumbar L5-S1 L4-L5
Discogram showed Shredded L5-S1
5 YO MRI of neck shows straightening of cervical spine, issues at C4-5 & C5-6 and C6-7 (central disk protrusions, bilateral uncovertebral joint arthropathy, moderate neural forminal stenosis, severe central stenosis with cord compression)
Aetna approved C6-7 replacement, scheduled for 11/17
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Old 05-26-2021, 05:02 PM
Cheryl0331 Cheryl0331 is offline
Senior Member
Join Date: Dec 2010
Posts: 890
Default Awesome Sauce!

I have BCBS of Oklahoma; I wonder how that compares. Thank you for sharing!
54 yr old female 5'7" 147 lbs. non-smoker conservative treatments failed
2007 fusion @ C4-6 peek cages, failed due to long term use of cox-2 inhibitor
2008 revised C4-6 donor bone, plate & screws
2009 fusion with Roi-C @ C3-4
2015 MRI & CT mjr ddd @ C6-7, segmental kyphosis at C7-T1, 2-level M6-C prosthesis by Dr. Clavel Barcelona Spain
2019 H.O. formed behind M6-C @ C6-7 left nerve rt & in spinal canal.
2020 Revision C6-7 to a CP-ESP prosthesis by Dr. Schmitz Dusseldorf Germany
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Old 06-29-2022, 03:41 PM
randolf's Avatar
randolf randolf is offline
Join Date: Apr 2015
Posts: 47
Default bsbc

Originally Posted by 1Day View Post
Shocker...looks like Blue Shield of CA now lists double lumbar ADR as an approved procedure, page 4!!! Might be time to change insurance.
i didn't see anything in the whole document about adr anywhere
2007 mri revealed all but 2 discs of entire spine are either bulged, some torn, a few herniated and compressing foramenal nerves or chord c3-4 fusion. myelomalacia at 2 levels, facet arthropathy, spinal and foramenal stenosis, yadda, yadda...
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Old 07-02-2022, 10:12 AM
phillyjoe phillyjoe is offline
Senior Member
Join Date: Jan 2013
Posts: 286

P 22 seems to say the opposite. it was removed from the policy
Pre Surgery:
C3-C4:Mild disc osteophytes. Mild-moderate right facet arthrosis. Mild right foraminal stenosis.
C4-C5:Midline central disc protrusion, significant. Mild canal stenosis.
C5-C6:Moderate disc osteophytes. Mild-moderate canal stenosis. Moderate-severe bilateral foraminal stenosis.
C6-C-7:Mild-moderate disc osteophytes. Mild canal stenosis. Moderate left and moderate-severe right foraminal stenosis.
June 29,2016-3 level M6 (C4-C7) Dr. Clavel Barcelona
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