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  #1  
Old 08-29-2016, 04:56 PM
RiverMiles RiverMiles is offline
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Default BCBS Anthem update: Two-Level Cervical ADR Covered

BCBS Anthem now covers 2LVL ADR for Cervies.

This is not the same policy change that took place (in June?) for BCBS in a portion of its footprint including Texas, Montana, Illinois, New Mexico, and Oklahoma.

My understanding is Anthem is one of the remaining "elephants" that LDR has been working on and that this policy change represents a significant leap in the number of patients covered for this procedure.

Anthem BCBS is not my insurer and I'm sure someone else could speak to this better than me but I believe their footprint adds members in California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia, Wisconsin?

This policy change went into effect on 8/18. The link below takes you to the policy brief - See the second paragraph under the heading, "Position Statement."

Sorry in advance if this is already posted but I couldn't find it anywhere else and I wanted to post it as soon as I could confirm.

https://www.anthem.com/medicalpolici...pw_a053354.htm
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Nov-Dec 2015 - 10 miles in the kayak, a N. GA mt summit, a 12-mile day-trek.
Late Dec '15-Mar '16 - Years of "normal" tension in my neck became radiculopathy w/ neuro deficits / Standard conservative treatments. / MRI reveals C5-C7 unpleasantness.
Apr 18th, 2016 - 2LVL ADR scheduled for May 3rd!.......Apr 29th, 2016 - Surgery unscheduled by insurance co.
May 2016 to present - Appealing. Summit the couch daily; trek to restroom/kitchen as necessary.
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Old 08-30-2016, 10:03 PM
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Harrison Harrison is offline
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Thank you, for sharing this important information!
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Old 09-01-2016, 01:49 AM
Sportinawoody Sportinawoody is offline
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Default

Is this particular to certain states? Pardon the ignorance but I'm new to this.
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Old 09-02-2016, 01:06 AM
RiverMiles RiverMiles is offline
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Default Good question

And I'm new at this too but I think this applies to group plans within the entire Anthem/BCBS footprint, so all states within their footprint. My understanding is the medical policy bulletins are meant to be fairly universal within a given plan. It's possible there could be an exception/exclusion written into a specific employer's plan language. If so you might be able to find that information in the summary plan description (SPD) for your plan.

So for cervical two levels the big players who are now on board include Anthem/BCBS, United Healthcare, Cigna, and some other tendril of BCBS that covers Texas, Montana,* Illinois,* New* Mexico,* and*Oklahoma. I don't think any of the BCBS federal plans cover disc replacement, only group plans. I think for Cigna and UHC two level coverage exists for both the federal and group plans. Just putting that out there because open enrollment is right around the corner.

Does that help at all/answer your question? Are you researching prospective plans or trying to determine coverage for your current plan?
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Nov-Dec 2015 - 10 miles in the kayak, a N. GA mt summit, a 12-mile day-trek.
Late Dec '15-Mar '16 - Years of "normal" tension in my neck became radiculopathy w/ neuro deficits / Standard conservative treatments. / MRI reveals C5-C7 unpleasantness.
Apr 18th, 2016 - 2LVL ADR scheduled for May 3rd!.......Apr 29th, 2016 - Surgery unscheduled by insurance co.
May 2016 to present - Appealing. Summit the couch daily; trek to restroom/kitchen as necessary.
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Old 09-02-2016, 01:48 AM
RiverMiles RiverMiles is offline
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But it would apply to the Anthem BCBS plans. BCBS has so many independent licensees and somehow a procedure that Anthem BCBS calls a new gold standard might be called experimental/investigational by Wellmark BCBS.
Sorry for the emphasis on cervies; just checked out your profile. Do you have BCBS-NC?
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Nov-Dec 2015 - 10 miles in the kayak, a N. GA mt summit, a 12-mile day-trek.
Late Dec '15-Mar '16 - Years of "normal" tension in my neck became radiculopathy w/ neuro deficits / Standard conservative treatments. / MRI reveals C5-C7 unpleasantness.
Apr 18th, 2016 - 2LVL ADR scheduled for May 3rd!.......Apr 29th, 2016 - Surgery unscheduled by insurance co.
May 2016 to present - Appealing. Summit the couch daily; trek to restroom/kitchen as necessary.
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Old 10-05-2017, 02:09 PM
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Tatonka_usn Tatonka_usn is offline
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Quote:
Originally Posted by RiverMiles View Post
I don't think any of the BCBS federal plans cover disc replacement, only group plans.
Any idea if there's been additional clarification on this? I have Blue Cross FEP, and am at the point of considering ADR for cervical issues.
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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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