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  #1  
Old 11-03-2010, 11:00 AM
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Harrison Harrison is offline
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Exclamation New BCBS Policy on Fusion

Please see attached, and read the exclusion criteria carefully (when lumbar fusion is not covered, page 3.)
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File Type: pdf NC_Fusion Policy_2011.pdf (260.7 KB, 26 views)
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Fell on my ***winter 2003, Canceled fusion April 6 2004
Reborn June 25th, 2004, L5-S1 ADR Charite in Boston
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Old 11-03-2010, 07:51 PM
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Harrison Harrison is offline
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Question

When Lumbar Spine Fusion Surgery is not covered

BCBSNC will not provide coverage for lumbar spine arthrodesis (fusion) surgery when it is considered not medically necessary.

1. Lumbar spine arthrodesis (fusion) surgery is considered not medically unless one of the above conditions is met.

2. Lumbar spinal fusion is also considered not medically necessary if the sole indication is anyone or more of the following conditions:

> Disk Herniation
> Degenerative Disk Disease
> Initial diskectomy/laminectomy for neural structure decompression
> Facet Syndrome

So when the hell is it possibly indicated?!

It would appear that this insurer is making less and less treatments available for people suffering with severe spine pain. So what new options are they providing patients? I don't get it; this seems like cruel and unusual punishment.
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"Harrison" - info (at) adrsupport.org
Fell on my ***winter 2003, Canceled fusion April 6 2004
Reborn June 25th, 2004, L5-S1 ADR Charite in Boston
Founder & moderator of ADRSupport - 2004
Founder Arthroplasty Patient Foundation a 501(c)(3) - 2006
Creator & producer, Why Am I Still Sick? - 2012
Donate www.arthropatient.org/about/donate
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  #3  
Old 11-04-2010, 12:32 AM
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Tatonka_usn Tatonka_usn is offline
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Wonderful! It's not like most folks even WANT to be fused, but now even THAT is becoming less of an option in the interest of preserving corporate profit. Maybe we should just send them our vertebrae as a downpayment??
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4/07:LBP + radiculopathy=severe L5-S1 herniation , 7/07:Micro-D, 08-09:Reherniation, 09-17: periodic residual symptoms (conservative modalities to maintain "stability" = prolotherapy, ESI/nerve blocks/facet injections, chiro, massage, phys ther), 7/17 pain in neck/right shoulder radiating into hand (no trauma involved), 7-10/17 Conservative treatment to date include physical therapy/dry-needling/facet-injections (C4/5 to C6/7). Researching surgical options should progression continue.
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