New to site--seeking insurance help!

[mindya]

40 yr old mother of 3
severe DDD
post hemilaminotomy L4,L5 L5, S1
recurrent disc herniation
endplate osteophytes
facet arthropathy

I have undergone multiple MRI's, CT's, epidurals, cortizone injections, massage therapy, discogram, pain killers, etc. Most recent surgeon, who has a reputation of being conservative, was referred by my pain management doctor. He is recommending lumbar fusion at L4,L5 and L5,S1. I was set for Nov 1st but was denied by Anthem BCBS as of yesterday, stating "no slippage, sponduloslistheses, or spinal instability" as well as "no record of severe narrowing where the nerves exit the spine." My provider is appealing and requesting a peer to peer review. After trying to avoid another surgery for the past 4 years since a hemilaminotomy at 2 levels and reherniating 5 months later, I had finally come to terms with having another surgery--only to be DENIED by BCBS. I am frustrated and depressed!! Any help, suggestions, etc. is greatly appreciated. mindya

[Justin]

Hi mindya,

Welcome to the Spine Patient Society.

I'm sorry your surgery was denied by BCBS. The good news is that most peer review appeals are approved, especially since your operation is a fusion.

Have a look around the Forum and please keep us posted on the outcome of your appeal. I wish you the very best.

[KBear]

I'm so sorry you are going through this. Spine issues are tough enough without fighting with the insurance company. Check out the insurance section on here, as I know that 1 or 2 of our members were denied fusion, but later it was approved. I think you still have a great shot at getting it covered, especially since it sounds like you have exhausted all conservative options. Best of Luck, Kathy