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lost bc/bs ins. appeal-I don't know what to do

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:19 AM in Lower Back Pain
Hi , My name is Lynn, this is my first time ever doing this. I need a two-level ADR at L4-L5 & L5-S1. I have annular tears in the discs, along with DDD, and the discs are all protruding.
This has been going on over four yrs now. I am at the end of my rope. I cannot believe all the pain you can be in, even being on pain meds.
I lost my appeals with the ins. co. I dont know where to go from here. I have Anthem Blue Cross/Blue Shield. What ins. covers this? :?


  • I also have Anthem BC/BS. You may wanna check the Insurance section of the forum. Maybe they still consider the ADR thing to be experimental or something? Good luck--Mazy
  • I have the same insurance... thought it was the best around. Can you appeal again? What about emergency government benefits?

    Hope this all works out for you...
  • dilaurodilauro ConnecticutPosts: 9,842

    For a Spine-Health Site introduction, Click on :

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    If you have any questions, feel free to contact (PM) any one of the Moderators here Priestess , Bruce , Paulgla, DiLauro

    The Spine-Health Web site offers so much more than these Member Forums.
    Check the various tabs at the top of the Spine-Health page and you will find so much that is offered here.

    Please feel free to contact me at rdilauro@gmail.com or send me a message

    We have a section devoted to Insurance items. Please take a look there, there might be more information available. I have found over the years that you did not to 'talk' with the insurance companies several times. I have treatments tnat my current Insurance carrier has rejected. This is being gone on for almost two years now. I keep writing lettings, get doctor memos to back up , look for articles in papers, magazines, etc to back up my claim.... They still say no. I am on about my 3rd time... DONT Give UP!
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • We changed to BC/BS for my recent surgery because hubby's insurance, which we had been covered under for several years and covered first back surgery, no longer had my NS in thier network. Thank goodness hubby works for a big company with good group coverage with 3 different insurance options. We now pay more out of pocket expense, but my NS was covered, so it was worth the change to me.
    I have heard that sometimes surgeries get denied the first and sometimes second time, but then are approved. So keep trying for approval, or if it's possible, look into changng insurances, if you are lucky enough to be in a big group coverage siuation like I was.

    Good luck!
  • Lynn, I am so sorry to hear about you losing the insurance appeal. I hope you would try the appeal again. I have read that it sometimes takes up to 5 appeals before it will be approved. Darn insurance companies--most of them only care about the bottom line, which is the "almight dollar". Maybe your Dr would change your pain meds to something stronger to help you out until you can get the surgery done. I am sorry you are in so much pain. Hang in there.
  • There was a post on the old SH that somebody had the same insurance as you and finally got it (ADR) approved. If I can remember who it was, I will let you know.
  • hi and welcome.
    i also have anthem they have been great.
    personally i am going to think its the ADR also.
    alot of insurance companies have a issue with this.
    have you discussed with your dr using your own bone as a graft???
    thats what my surgeries were with.
    they were approved the day the surgical scheduler called them.

    keep up checking this out.
    don't give up hope!!!
    let us know
  • Lynn,
    Seems to me there have been a few posts on here that say insurance will not cover 2 level ADRs in the US. You might want to do a search. I also vaguely remember seeing that it took some preserverence to get authorization for one level ADR as well. Try looking in the insurance section. Sorry I'm not more help.
  • http://www.anthem.com/medicalpolicies/policies/mp_pw_a053354.htm

    Currently, 3 intervertebral devices have FDA approval. The Charité™ and PRODISC-L® devices are used for lumbar disc replacement. The PRESTIGE® device is used for cervical disc replacement.

    Artificial intervertebral discs such as the BRYAN® (cervical), Maverick™ and FlexiCore™ (lumbar) have been developed. At this time, these devices have not received FDA approval.
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