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1st Level Appeal Denial

This is a discussion on 1st Level Appeal Denial within the Health Insurance forums, part of the Insurance and Travel Forums category; Sooo...I'm not surprised, just frustrated. I'm going to wait to tackle the 2nd level appeal until next week. I've decided ...

  1. #1
    Senior Member bigdogchief76's Avatar
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    Default 1st Level Appeal Denial

    Sooo...I'm not surprised, just frustrated.

    I'm going to wait to tackle the 2nd level appeal until next week.

    I've decided to declare war on Aetna and the Medical Director (figuratively...just wanted to clarify so no one takes that the wrong way...lol) While I shouldn't have to fight this, it's just the way it is with these insurance companies. I think Dr Bruce Banner said it best..."Don't make me angry...you wouldn't like it when I get angry..." (cue the dramatic music, then the "Lonely Man" song from the Incredible Hulk...lol)

    Denying a lumbar fusion...it seems barbaric.

    I'll let everyone know how the 2nd level appeals works out.

    MB
    Matt Brown

    L5-S1 DDD with retrolisthesis, central HNP and severe discogenic pain
    18 March 2011 - Pro-Disc L installation
    Proud Air Force Veteran
    Daddy to 2 beautiful little girls

  2. #2
    Founder / Administrator Justin's Avatar
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    Default Re: 1st Level Appeal Denial

    Good luck, Matt! Play your cards right and don't jump right in to your next appeal. Insurance companies are evil.

    Denying a spinal fusion.

    Justin Averna
    Founder & President, Spine Patient Society™
    www.SpinePatientSociety.org
    A 501(c)(3) Tax-Exempt Nonprofit & Charitable Organization


    • 1994: Football Injury, Severe Hyperextension
    • 1997: Snow Skiing Injury
    • 3/7/1997: Laminotomy L4/L5
    • 1999 & 2003: Motor Vehicle Accidents (not at fault both times) --> Grade V Annular Tears L4/L5 & L5/L6
    • 11/15/2003: 2-Level ProDisc® L4/L5 & L5/L6*, *lumbosacral transitional vertebra --> Dr. Rudolf Bertagnoli
    • 4/2008: 4.5 years pain-free before "new" leg pain
    • 5/14/2009: Dynamic Stabilization System L4/L5, Dr. Rudolf Bertagnoli
    I'm here to help.
    Questions? Suggestions? Need help with registering, creating a signature, etc.?
    justin (at) spinepatientsociety.org


    Disclosure: I have no financial relationships with any surgeons, spine clinics, device manufacturers, pharmaceutical companies, hospitals, etc. -- the SPS Board of Directors serve without compensation.

  3. #3
    Moderator Cindylou's Avatar
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    Default Re: 1st Level Appeal Denial

    Quote Originally Posted by Justin View Post
    Good luck, Matt! Play your cards right and don't jump right in to your next appeal. Insurance companies are evil.

    Denying a spinal fusion.
    I couldn't agree more. It is barbaric. It's the new tactic of the insurance companies, to deny even a gold standard treatment, such as the fusion. We just cannot let them win this one. It's so wrong on so many levels. I wish I knew what more I could do to support you Matt, and every other "Matt" who is refused a fusion. I will keep you in my thoughts and prayers, and like Justin suggested, wait a bit before you arm yourself for battle again. Good luck! Go kick their a$$. Cindylou
    • January 2000 MVA passenger, used jaws of life to retrieve me, neck injury and months of PT
    • June 2001 Bicycle accident, 2 compression fractures at T12/L1, Vertebroplasty Sept. 2001
    • April 2006 right hip, labral tear and repair
    • April 2007 3 level ProDisc @ L3/4, L4/5 & L5/6✷ ✷Lumbosacral transitional vertebra; Dr. Rudolph Bertagnoli
    • July 2, 2008 ALIF & Laminectomy @ L6/S1
    • July 30, 2008 re-opened 28 days later to remove bone cement that had leaked onto S1 nerve root
    • August 2008 Pulmonary embolism, double pneumonia, collapsed left lung, re-hospitalized 1 week
    • March 10, 2009 Right SI Joint Fusion
    • April 27, 2010 2nd right hip arthroscopy to remove adhesions and release psoas muscle
    • September 30, 2010 lumbar facet rhizotomy
    • December 9, 2010 12 bilateral lumbar trigger point and steroid injections
    • December 23, 2010 12 more bilateral trigger point injections w/o steroid
    • February 15, 2011 ESI bilaterally in lower lumbar...relief only for few days. Considering 1 more.
    Did Spinal Cord Stimulator trial from 5/11/11-5/17/11 with excellent results; Spinal Cord Stimulator surgery is Monday,
    July 18, 2011

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