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Blue cross anthem not pay for RFA of neck, feedback?

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:35 AM in Neck Pain: Cervical
Blue Cross Anthem of Wisconsin will not pay for Radio Frequency abblation of cervical 4-5 6-7. Other steroid injections do not help. Just use heating pad, naproxen, and chiropractor. Did anyone else with Blue Cross get it paid for? In my area it would cost me $ 11,000. thanks, J


  • HI JJ,
    First let me say welcome to spine-health. Why did they turn down the request for the RFA? Please make sure you appeal this. Sometimes it takes 2-3 times on appeal. The doctor will need to write the specifics as to why he/she is wanting this procedure. They will hope that you will just give up on the procedure. It shouldn't be considered experimental. Good luck and keep us posted. Once again welcome to spine-health.
  • As I understand it, if a series of epidural spinal injections fail, then the patient is not considered a candidate for RFA. Perhaps that is why insurance will not cover the procedure??

    If your doctor feels it will help, I would think he would have success in appealing the decision.
  • jlrfryejjlrfrye ohioPosts: 1,110
    Hi JJ
    Appeal with anthem and make sure you include a letter of medical necessity along with medical records that support the need for the procedure. Ask for an expedited appeal due to the unnecessary pain and suffering that the denial is causing you. If you lose this appeal file a level 2 appeal. Also ask your doctors office to file an appeal. I do medical billing for a living so if I can help in any way just let me know.
    Also include all previous procedures done that have not been successful.
  • hi, I have bluecross, problem lays in RF, since is temporary fix and have to be repeated, I guess.
  • In my area the doctors do an injection first to see if you get any relief. It is my understanding that if there is no relief, that RFA will not help. I had a series of facet injections for this specific purpose, but did not proceed RFA any further because I had absolutely no relief from the injections. Could this be why BC is not approving the procedure? In any event, if your doctor feels this will help you, definitely do the appeal process mentioned above. It may also help to get a second doctor recommending the same procedure to reinforce the need as you fight the "powers that be" to get it approved.

    Good luck!

    Surviving chronic pain one day at a time, praying for a reprieve because living another 40 years like this doesn't sound too fun!
  • Thanks for the feedback on the RFA on my cervical spine. Yes, the local "test injections" did work, so the next step is the RFA. My doc did appeal, but yeah, I will keep trying.

    Also, Ultrasound at the chiropractor, does this help anyone with scapular area spasms? JJ
  • Thanks for your tips. I will definitely not give up.
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