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Waiting for approval from BCBS-anyone have experience with this?

hshrabelhhshrabel Posts: 1
edited 10/28/2014 - 6:23 AM in Back Surgery and Neck Surgery
Hello, first time poster. I have a degenerated disc L5-S1 that is herniating into my spinal nerve bundle and sciatic nerve. I have seen two different surgeons and have chosen a good one here in Dallas. He says the disc needs to be removed and I am waiting to see if BCBS will approve an artificial disc instead of the fusion. Does anyone have experience dealing with this insurance and has anyone had them approve the artificial disc? Any help would be appreciated. Hope I'm posting this in the right place.
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Comments

  • LizLiz Posts: 9,720

    Liz, 

    Veritas-Health Forum Moderator

    Spinal stenosis since 1995
    Lumber decompression surgery S1 L5-L3[1996]
    Cervical stenosis, so far avoided surgery
  • Yes, I had to approve my 2 level fusion through BCBS as well. It is a lengthy process and in my case, it took approximate 6 weeks. They gave me a case number though, so I could call to inquire the status, if they needed anything from me, or just see if anything was being done on my case. It is a long time to wait, but my file was 98 pages! If you consider how much content was in there, 6 weeks doesn't seem too outrageous, but it felt like an ETERNITY to me, because I was living every minute of it in PAIN. My surgeon's office handled all the preoperative approval requests, and after I sent me all my records, they were the ones who assembled it in the format BCBS required. I think that is something that helped support my case, and I hope your doctor's office does the same for you.

    Your case is unique, so don't look at mine as any benchmark. Try your best to remain positive and let the facts speak for themselves. I found BCBS to generally be very helpful and knowledgable.
    2015: Thoracic protrusions C7-T1, T3-4, T6-8
    Dec'13: 360FusionL4-S1 w/bone graft
    2013: 3x2-level disc injections: 12mo surgery postponement
    Dec'12: DiscogramL4-S1
    Sep/Oct'12: Bi-lateral Rhizo AblationsL4- S1
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  • As to your question about artificial discs, what my neurosurgeon told me is that artificial lumbar disc replacements are generally not approved by insurance in the US. But I know of some people who have had them in other countries. My surgeon didn't recommend one for me due to the fact that little is known on how they stand the test of time, with the weight of your whole body on them (lumbar) and the huge risk of having to potentially replace one. But that differs by whom it is you ask.
    2015: Thoracic protrusions C7-T1, T3-4, T6-8
    Dec'13: 360FusionL4-S1 w/bone graft
    2013: 3x2-level disc injections: 12mo surgery postponement
    Dec'12: DiscogramL4-S1
    Sep/Oct'12: Bi-lateral Rhizo AblationsL4- S1
  • jlrfryejjlrfrye ohioPosts: 1,111
    Most policies will not pay for artificial disc saying they are experimental. There are ways for your Dr to get around this but proof will need to be shown that all other options failed. Good luck
    Susan
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