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denial of revision spine surgery, now waiting..anyone gone through this??

Danigirl123DDanigirl123 Posts: 60
edited 05/02/2014 - 6:41 AM in Back Surgery and Neck Surgery
My insurance company which is fairly new because we just switched denied my revision surgery. I underwent a multi level fusion last June with rods and screw and there are a couple things going on in there. One, I have a screw that's in the L1 nerve that needs to removed. I havent fused at all at almost 1 year post op and I'm still in so much pain. My doctor put in for an appeal and now I'm just waiting. My doctor said unfortunate this is very common now for them to deny a revision. If I have to live like this for the rest of my days I will go nuts!! Anyone have a denial and got a pproved? I have BCBS PPO so that's why I was boggled by how they denied it! Any words of advice reassurance or anything will help!
Thanks all!
28 F. Chicago. Fusion from t-12 l-4 from scoli in June 2013. Torn bilateral hip labrums. Arthroscopy to fix labrums January 2013 and march 2013. SI pain from hip surgery Lupus, RA, antiphosphidlipid antibody- hypermobility syndrome ( Marfan syndrome)


  • jlrfryejjlrfrye ohioPosts: 1,110
    Your Dr needs to send in a expedited appeal with all documentation showing why the surgery needs done. Most denials are due from lack of evidence. Along with your Dr appeals you need to appeal the claim yourself. Get copies of the documentation and document the amount of pain the denial is causing . Call and ask for a supervisor and ask what is it that is stopping the claim, if you need any help pm me, i do this for a living
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