Am I good? Bad? Or is BCBS-TX just that slippery?

**jss** · 12-27-2010, 10:48 AM

Good luck Dennis. Here's wishing for a Happy New Year for the both of us!

**bman** · 01-05-2011, 02:04 AM

I don't know how else to explain this except that I prayed diligently for the Lord to either "open doors" or ....not, and I was accepted by Tx BCBS after the hoops of MRI, CAT w/Contrast, and Discogram (withOUT any BeeGees music, btw

I expected a fight(especially reading about all the denials and it being so close to years end, but I then resigned myself to the mindset that if it was denied, I probably wasn't supposed to have it in the first place....
I will say I had an INTERNAL disc herniation ...> than 1cm. With absolutely NO facet involvement. My surgeon ( who is published in FDA trials on ADR, told me that facet involvement will result in insurance forcing XLIF instead of ADR.
Best of Luck
Bman

**dyates** · 01-05-2011, 02:24 AM

Was it multiple levels?

I have been approved for one level, but they denied the other two... My appeal is still collecting dust at the Teacher Retirement System in Austin. Since it is fully self funded, I cannot even go to the Texas Insurance Agency. They have no jurisdiction...

I found this out because I wrote every government official from down the street to the White House. So far, I have had a couple of canned responses referring me to the state. Tomorrow I have to write back and explain that they are my last hope.
I am learning alot about managed healthcare for sure... I will follow up tomorrow. Thanks for the reply!

**Justin** · 01-05-2011, 10:20 PM

Originally Posted by bman

I don't know how else to explain this except that I prayed diligently for the Lord to either "open doors" or ....not, and I was accepted by Tx BCBS after the hoops of MRI, CAT w/Contrast, and Discogram (withOUT any BeeGees music, btw

I expected a fight(especially reading about all the denials and it being so close to years end, but I then resigned myself to the mindset that if it was denied, I probably wasn't supposed to have it in the first place....
I will say I had an INTERNAL disc herniation ...> than 1cm. With absolutely NO facet involvement. My surgeon ( who is published in FDA trials on ADR, told me that facet involvement will result in insurance forcing XLIF instead of ADR.
Best of Luck
Bman

Great news, Bert!

**runagain** · 01-06-2011, 04:02 AM

Hey Guys,

Welcome to the circus called Blue Cross (Well Point, Anthem, etc...).
Two different levels/surgeries, zippo result.
Score: Well Point 2, me 0.
sorry.