Spine Patient Society Plays a Pivotal Role in Recent Uproar Regarding the New North Carolina BC/BS Policy on Spinal Fusion Coverage

[stogner245]

Thanks for that update and additional information. I had read this in some of the policy changes and it is sickening. I am fighting a battle and have a meeting with an attorney monday to go over all the evidence i have accumulated against bluecross. I think we may be able to build a case for unfair trade practices. I also think i will be able to really have a claim against the so called regional medical director who chose to ignore all the evidence and letters from my doctors, as well as ct reports, mri reports, xray films and had the nerve to put in writing that there was nouthing in my file to justify a policy review or reversal. He put all this in writing and I feel sure that I can initiate a case with the insurance comissioner and the nc medical board for him falsifying his exam review findings to make himself look good to his employer, bluecross of n.c. They can not be allowed to continue to do business like this while all along, the board of directors all get a million dollar bonus on avg. the ceo got over a 3 million bonus last year. I wonder how much this idiot of a doctor got for ignoring the facts. He will not even see what is coming before the medical board gets to drop an investigation into this matter. thanks and i would love to hear more about what is valid and printable to present to my attorney next week.

[Cindylou]

Thanks for that update and additional information. I had read this in some of the policy changes and it is sickening. I am fighting a battle and have a meeting with an attorney monday to go over all the evidence i have accumulated against bluecross. I think we may be able to build a case for unfair trade practices. I also think i will be able to really have a claim against the so called regional medical director who chose to ignore all the evidence and letters from my doctors, as well as ct reports, mri reports, xray films and had the nerve to put in writing that there was nouthing in my file to justify a policy review or reversal. He put all this in writing and I feel sure that I can initiate a case with the insurance comissioner and the nc medical board for him falsifying his exam review findings to make himself look good to his employer, bluecross of n.c. They can not be allowed to continue to do business like this while all along, the board of directors all get a million dollar bonus on avg. the ceo got over a 3 million bonus last year. I wonder how much this idiot of a doctor got for ignoring the facts. He will not even see what is coming before the medical board gets to drop an investigation into this matter. thanks and i would love to hear more about what is valid and printable to present to my attorney next week.

Go get 'em Larry!! Good luck!! Cindylou

[Justin]

See the new thread in the Educational Forum that spells out spine surgery denials across the United States: What's That Smell? (Rising Rates of Spine Surgery Denials).

[Justin]

See the new thread in the Educational Forum about the spine device companies are feeling the effects of new spinal fusion policies: Spine Device Companies Feel Backlash Against Spinal Fusions.

[Justin]

See the new thread in the Educational Forum about the Milliman Company, which independently develops and produces "evidence-based clinical guidelines" that insurance companies use to help make policies like the newly implemented Blue Cross Blue Shield of North Carolina spinal fusion policy:

"Milliman Made Me Do It" (Denying Coverage for Spinal Fusion Procedures).

[runagain]

Justin,

After years of fighting insurance companies and their idiotic policies, I am not surprised at what they are doing. My latest fight was regarding my doctor who was out of network. A year ago, the reimbursement was 82 dollars out of a $180 bill. This was after meeting the $750 deductible. Then in 2010 the reimbursement dropped to $42 and in 2011, they went from $42 to zero and hence stopped paying anything, leaving the entire bill for me to pay.
I told my doctor what was going on and she told her billing person and they found out the doctor needed to write a care plan and a different diagnosis and then the insurance company approved what they had denied. They actually reimbursed retroactively. The billing person found this out by accident when calling the insurance company on my behalf, it was not written in any policy the doctor received from the insurance company.
Subsequently, the doctor's biller went and applied this to other patients the doctor takes care of.
I was happy not to have to call the insurance company because my questions would have probably been met flatly with the word, denial.

The insurance companies' policy seems to be to weed out their expensive customers (patients) and then reduce the reimbursement for procedures, office visits, surgeries and the like. Hence increase their profits and give their CEOs a bigger bonus.

I am glad to see that the spine societies and their members sent a strong and definitive message to the insurance company. They cited the latest evidence-based practice.
When I was researching my Blue policy for ADR, up-to-date studies on ADR that were pro-ADR, were omitted in the companies' policy. Just like the information did not exist.

R