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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 04-30-2011, 11:31 PM
chrislaxtell chrislaxtell is offline
Junior Member
Join Date: Apr 2011
Posts: 2

i am new to this but am very interested in lawsuite against bc. i have bcbs of north dakota through my employer and they are saying pro-disc adr is investigational. i am in the process of sending 2nd appeal.
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Old 05-01-2011, 08:29 AM
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Jstuckey Jstuckey is offline
Senior Member
Join Date: Nov 2010
Posts: 305

Best wishes. I appealed my insurance (not BCBS) 4 times and was still denied with the "investigational" claim. In my case, they said (only on the last appeal when actually looking at my entire medical record) that it was the multiple level deterioration that had not been studied, therefore making it investigational for that use. (I would have had a fusion below and 1 ADR). So they would have paid if it was a single level? I highly doubt it....
Borrowing a ****load of money from my parents instead....
Joey Sue - 50 years old
9/28/2011: Hybrid STALIF TT interbody fusion at L5-S1 and M6-L ADR L4-5 with Nick Boeree, UK - forever grateful to you Nick! Still doing great.
Prior to the fix: Severe DDD L4-5 and L5-S1 with moderate facet degen at L5-S1, but only mild facet degeneration at L4-5.
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Old 08-29-2011, 09:16 PM
semathes semathes is offline
Junior Member
Join Date: Aug 2011
Posts: 6
Default Anthem BCBS L5-S1 denial

I would like to join forces with anyone who has experience with Anthem BCBS or any other BCBS for that matter.

I'm in need of any successful coverages, appeals, court cases, etc. for lumbar ADR.
2007 lower back pain becomes continuous, original cause unknown
2010 physical therapy, xray, mri, pain meds, muscle relaxers
2011 diagnosed with bone on bone at L5-S1, bone loss occurring, 3x epidural steroids injections, continuous pain meds, ct scan, denied ADR by Anthem BCBS
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Old 09-22-2011, 10:42 AM
christinlal christinlal is offline
Senior Member
Join Date: Nov 2010
Posts: 103
Default Blue cross

We sent a summarization of my nightmare to a health care attorney.
12/2008 early am gym class-something very wrong
2/2009 DDD 4 herniated cervical discs
3/3009-8/2009 8 spinal epidurals, pt
09/2009 C6/7 Prodisc C ADR
11/2010 facet joint inj 12/2010 Rhizotomy TBI Dr. Cottingham months of relief
05/2011 facet Joint Inj 06/2011 Rhizotomy
7/2011 Dr. Zigler TBI, facet block and Discogram
11/18 surgery with Dr/Mr. Boeree..Thank God.
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Old 09-30-2011, 08:56 PM
andrea32225 andrea32225 is offline
Junior Member
Join Date: Sep 2011
Posts: 1

I'm in the midst of a battle with Anthem myself. Just got my first denial back today. Am waiting to see if they will approve a repeat discectomy (which will leave so little disc they will have no choice but to do a fusion or ADR), before I decide about the 2nd appeal. Will hopefully know something Wednesday. Evidently our Anthem policy is the only type that does not require pre-cert for lumbar fusions!

Thought this was on my signature already - 2x epidural spinal injections, 3 mos physical therapy, herniation at L5-S1 w/microdiscectomy on 7/5, re-herniation shortly thereafter

Doctor who performed appeal made numerous factual errors based on info submitted by doctor to go with appeal. Does that matter in anything?

Last edited by andrea32225; 09-30-2011 at 08:58 PM. Reason: adding conditions
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Old 05-24-2012, 11:57 AM
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Jmbeam Jmbeam is offline
Senior Member
Join Date: Oct 2007
Posts: 111

Has anyone been successful in Suing BCBS?
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Old 06-06-2012, 05:03 PM
ally ally is offline
Junior Member
Join Date: Jun 2012
Posts: 17

I am very intereted in BCBS as I hav it in Alabama and was told that disc replaement would not be covered. I am also planning on getting a lawyer when the decision is made on what Dr. I go to and what disc is decided that would be best for me. Im such a noob here also lol.
Diagnosed with DDD on my L3/L4 and L5/S1
Have not had a second opion yet but will do that when i get all my results officially. Tried PT and also shots with no relief.
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