Any success with Regence BCBS?

[Dilentz]

Hello

My husband suffered for nearly one year from disc degeneration at levels C3/4-C6/7. Last February 2010 he had a very successful operation at Stenum Hospital, Germany. They fixed all four levels but because of limited space and that the upper and lower levels had pretty muched fused themselves, they were able to do only two levels of ADR and two fusions by cage. His C3/4 and C6/7 had the fusions and the other two levels, C4/5 & C5/6, with the Mobi C. We originally had hoped to have the M6 at the top three levels, but he had very little disc space and thus the Mobi-C was the narrowest disc. In hind sight we are very glad for this decision and so appreciative of the experience at Stenum. He experienced no distraction pain and was out of pain wih full use of his right arm as soon as the operation was complete. We were extremely pleased with our experience at Stenum and with his outcome.

However, we are still fighting our insurance carrier, Regence BCBS. We have been denied twice and am now preparing it to go Indepedent Review. Has anyone had success with Regence? If so, could you send me a copy of your approval? My husbands' company however, has just switched to BCBS of Illinois and I believe they have a positive coverage. Anyone have success with them? Since the company is a self funded plan we are also appealing directly to them.

Thanks for your help!

[KBear]

Since the company is a self funded plan we are also appealing directly to them.

I believe (and I may be wrong) that since the company is self funded that they have the say in if it will be covered. I would go to the HR department and appeal to them. Good Luck.

[Cindylou]

Yes, that is absolutely true Kathy. They do have a say, a big say. Dilentz, welcome to SPS, and it is great news to hear how successful your husband's surgery was at Stenum. Thank-you for sharing. I can't really help you with your insurance coverage as I am not familiar with them. I would just offer to keep at it, and bug, bug, bug, the heck out of them. I can't imagine that the new coverage you guys have would go near any appeal, since the surgery took place under a different policy, but I could be way off on that. This is a question for Laurie Todd, The Insurance Warrior, I believe. I would also recommend buying her book, as it has a wealth of knowledge in it. If you google her name, that should give you information to click on about her. Good luck! Cindylou (also, we have a forum about Insurance, and if you click on that, it will provide you with valuable information as well.)