Anyone have a fusion done with BCBS insurance????

[Greg]

A member of our group (gwin) is going through the typical bs we hear about from insurance companies when trying to get ADR but he is trying to get a good ole standard fusion but they haved denied him. It is unbelievable how similar his situation wass to mine (same insurance company, some of the same conditions, same procedure denied, same reasons....hell he even has the same name)

I was denied a fusion by BCBS for my 2 level DDD and herniated discs.....I eventually got the fusion approved but shouldn't have had to fight them. So my case is one for him to use in his fight for his life but he needs our help.

Have any of you had a spinal fusion done and had BCBS pay for it??? It doesnt matter what level, we just need to give him some hard facts of cases where BCBS has paid for a fusion (like they should but are screwing him around) for him to use in his battle to prove to them they are flat out wrong in denying him these services. From talking to him he sounds like he's physically in pretty bad shape and could almost classify his surgery as a medically emergency. So anyone who has BCBS and has them pay for a fusion if you could assist with approval letters you would be doing the spiney world a great favor.

Maybe your situation will or wont help but I think it would be better to ask for anyone with a BCBS fusion and sort out whether their diagnosis will help his case than be too specific and have someone think their case wouldnt help when it really would.

ADR has usually been the tough fight with insurance and I know there are approval letters in this section of the forum but this is not very common for fusion so we need your help. Please help our fellow member and reply or PM me (or "gwin", the person being denied fusion by BCBS)

[KBear]

Completely off topic, but I just got switched to BCBS TX in January, as our insurer left TX and BCBS took over with no pre-existing conditions and guaranteed acceptance (so I had to take it). Anyhow, Unicare, my old insurer, paid for all my medications, at most a pre authorization was required, but as soon as my doctor filed it out, it was always approved (and I thought they sucked). BCBS of TX however has informed me that they don't pay for antidepressants in TX. I have to pay out of pocket for them. My doctor has just submitted a new form for Cymbalta stating it is being used for pain, not depression (which technically it is, as that is the only reason for me to switch from Wellbutrin- which I can get in a generic for $40 a month, Cymbalta is $130 a month). BCBS told me that the only way the Cymbalta will be covered is if it is for pain and documented that other things failed. Guess we will see what happens; but I have never heard of anti-depressants not being covered. I think it also has to do with us having a self employed policy, not through an employer.

[Cindylou]

That's crazy Kathy! I have never head of such a thing. Talk about archaic. I would take them to task on that one for sure! Good luck.