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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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  #1  
Old 09-25-2015, 08:52 PM
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mhbussink mhbussink is offline
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Default Anthem BCBS denial overturned at external review

I received a letter from the IRO that reviewed my case 2 days ago. The denial for c5-c7 mobi-c disc replacement by Anthem BCBS was overturned! ! LDR patients advocacy program took care of evething for me. If anybody needs help with appealing a mobi-c disc replacement surgery LDR patient advocacy program may be able to help you get approved. It's a long process but it's worth it.
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C5-C6 decompression/fusion on December, 6th,2017. C5-C6,C6-C7 mobi-c disc ADR on October 16, 2015 by Dr.Charles II. L4-L5-S1 fusion September 2013 by Dr. Charles Edwards II.
Injured back in 2002 training in the Navy Seabees.L4-L5-S1 vertebrate were showing calcification from rubbing against each other with retrolesthesis before I submitted to the fusion surgery in 2013. My neck got bad in January 2015. Moderate & severe degeneration c5-c7 w/spinal cord indentation and nerve root compression.
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Old 09-26-2015, 02:13 AM
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scoop302 scoop302 is offline
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Congratulations, that is good news. When are you going for surgery and where?
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1979 car accident: rear ended
1980 ACDF C4-5
4/8/11 stopped, hit again
3 epidurals, PT, 2 MRI's,etc.
scheduled 3 times for C5-6, 6-7 fusion,
plus laminectomy at C3-4, and C 7, advised to do Bilateral lamino-foraminotomy C5-6, C6-7,a Percutaneous Discectomy L4 -L5
7/14 RFA on L3 to L5 (awake, local only)
C5-6,6-7 M-6 ADR with Dr. Clavel 9/17/14,
12/7/15 RFA L2-S1, Facet injections C2-7
6/3/16 RFA L2-S1, epidural L4,5, 8/26/16 RFA C1-7
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Old 09-26-2015, 10:30 AM
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mhbussink mhbussink is offline
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Thanks. DR.Charles Edwards I I at Mercy Medical Center in Baltimore MD on October 16th. Maybe sooner if there is a cancellation. 20 days to go.
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C5-C6 decompression/fusion on December, 6th,2017. C5-C6,C6-C7 mobi-c disc ADR on October 16, 2015 by Dr.Charles II. L4-L5-S1 fusion September 2013 by Dr. Charles Edwards II.
Injured back in 2002 training in the Navy Seabees.L4-L5-S1 vertebrate were showing calcification from rubbing against each other with retrolesthesis before I submitted to the fusion surgery in 2013. My neck got bad in January 2015. Moderate & severe degeneration c5-c7 w/spinal cord indentation and nerve root compression.
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  #4  
Old 10-08-2015, 07:51 PM
Jerry5 Jerry5 is offline
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Join Date: May 2013
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Default Bcbs

...they are starting to realize, yes, ADR do work and yes, people are productive again, and they PAY for their PREMIUMS, while working.

Good Luck, in the neck, I would go with Mobi-C, from what I am told.
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Jerry, Somewhere Ohio

L2-3 herniation, two days before Thanksgiving, 2012, Discectomy/Laminectomy, 3/13 Numbness in the right leg, lateral femoral, gone, July 10, 2014 L45 M6 ADR, July 15 PLIF L5-S1, Not able to access L51 Anterior.
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