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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 06-06-2009, 06:12 PM
cavalier cavalier is offline
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Join Date: Nov 2004
Posts: 112
Default Anyone with BCBS of TN ?

Hey there - Just wondering if anyone with BCBS of TN has had ANY luck in getting any part of their ADR surgery paid for as of yet?
If approved or even turned down would appreciate your posting.
Thanks Jill
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  #2  
Old 06-06-2009, 07:38 PM
jchebert1979 jchebert1979 is offline
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Join Date: Apr 2009
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Default

You need to check BCBS TN's policy. Do you have an online account? If not you should probably set one up anyway.


Just type BCBSTN in google. Register with them and then use the search engine or their medical policy link to find the criteria for ADR's.
__________________
Chiari 1 malformation - successful surgery 1-22-09
C5-6 herniation (extrusion) with moderate central canal stenosis and bilateral foraminal stenosis.
Prodisc-C @ C5-6 5-28-09

Herniations/Buldges @ C4-5, C6-7, C7-T1, T1-2, T3-4, T6-7, T11-12
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  #3  
Old 06-06-2009, 08:38 PM
Jdouglas Jdouglas is offline
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Join Date: May 2009
Posts: 33
Default Maybe not now, but soon...

Jill,

It appears from their website that they do not currently approve it, but there is also a Policy Statement Draft on the site that can be found by typing "Artificial Intervertebral Disc" as a search term on www.bcbst.com . I downloaded the attachment, which is in pdf. and posted it here. It essentially appears to be a forthcoming reversal of their policy in reference to Cervical ADR only, but once again is only a draft. It was written on May 28th, 2009 according to the properties. Does this help or does it help confuse things??? You can actually go to this web page: http://www.bcbst.com/DraftMPs/ and use the reference number for this draft to e-mail comments to them regarding it. Good luck.

-----------------------------------------------------------------------------
L5S1 Herniation and Annular tear
Over 10 epidurals,
DDD, 2 discograms (positive),
Countless attempts at conservative therapy.
Prodisc-L, Surgery date 5-26-09
Attached Files
File Type: pdf Artificial_Intervertebral_Disc.pdf (70.7 KB, 9 views)

Last edited by Jdouglas; 06-06-2009 at 09:09 PM.
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  #4  
Old 06-13-2009, 04:54 PM
cavalier cavalier is offline
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Join Date: Nov 2004
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Yes I found this same draft - it is open for comments up til June 28th and we have sent in comments to the e-ml address for this.

The thing is this draft is only allowing one level but the FDA has allowed for Compassionate use more than one level as dictated by your doctor. Some with this same insurance BCBS PPO are getting paid for multiple Cervical ADR's overseas but not under Tn. as of yet. I dont know how that works if each state has it's own ability to make or be different from another in the same coverages and company.
Anyone?

Thanks Jill
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